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Ciuffo G, Morais A, Landoni M, Costa R, Pinto TM, Lamela D, Jongenelen I, Ionio C. Assessing mother's childbirth-related posttraumatic stress disorder during the first year postpartum: a systematic review. J Reprod Infant Psychol 2024:1-108. [PMID: 39081034 DOI: 10.1080/02646838.2024.2382876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/16/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND AND AIM PTSD after childbirth is a significant but often under-recognised mental health problem. This systematic review aims to examine the measures used to assess childbirth-related PTSD (CB-PTSD) and posttraumatic stress symptoms (CB-PTSS) in mothers in the first year postpartum and to evaluate their psychometric properties. METHODS Following PRISMA guidelines, a comprehensive search of multiple databases and grey literature sources was conducted. Studies that involved mothers in the first year postpartum and reported measures of CB-PTSD and/or CB-PTSS were included. Quality assessment was based on the CASP Checklist. RESULTS 149 studies met the inclusion criteria. Self-report questionnaires, particularly the IES and its revisions, were the most commonly used measurement instruments. In recent years, however, specialised instruments such as the City Birth Trauma Scale have emerged that were developed specifically for assessing CB-PTSD. Psychometric properties varied from study to study, with some lacking detailed information on validity and reliability. CONCLUSION The results emphasises the importance of using validated and tailored tools for the assessment of CB-PTSD. Whilst self-report questionnaires remain widely used, the development and use of specialised instruments such as the City BiTS provide greater precision in the assessment of CB-PTSD symptoms. Future research should focus on refining measurement tools, conducting longitudinal studies to explore symptom trajectories, and investigating the effectiveness of early intervention strategies. By refining measurement methods and intervention approaches, clinicians can better support mothers with CB-PTSD and ultimately fostering improve the mental health outcomes for both mothers and their families.
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Affiliation(s)
- Giulia Ciuffo
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Ana Morais
- Digital Human-Environment Interaction Labs, Lusófona University, Porto, Portugal
| | - Marta Landoni
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
- CRIdee, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Raquel Costa
- Digital Human-Environment Interaction Labs, Lusófona University, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Tiago Miguel Pinto
- Digital Human-Environment Interaction Labs, Lusófona University, Porto, Portugal
| | - Diogo Lamela
- Digital Human-Environment Interaction Labs, Lusófona University, Porto, Portugal
| | - Inês Jongenelen
- Digital Human-Environment Interaction Labs, Lusófona University, Porto, Portugal
| | - Chiara Ionio
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
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Suchanecki L, Goutaudier N. Childbirth as an anticipated trauma during pregnancy: pretraumatic stress symptoms in primiparous women. J Reprod Infant Psychol 2024; 42:668-680. [PMID: 36266766 DOI: 10.1080/02646838.2022.2137118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/09/2022] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Women can develop anticipated traumatic reactions related to the forthcoming delivery through "pretraumatic stress" symptoms. The present study aims at: a) exploring the frequency of probable pretraumatic stress disorder in primiparous pregnant women, b) evidencing associated features of pretraumatic stress symptoms and c) exploring which specific components of antenatal anxiety are associated with pretraumatic stress symptoms. METHODS A sample of 100 primiparous pregnant women completed an online questionnaire assessing pretraumatic stress, fear of childbirth, depressive and anxiety symptoms. Socio-demographic and pregnancy-related data were also gathered. RESULTS 8 % of women met all criteria for probable pretraumatic stress disorder. Increased depressive symptoms (ß = 0.48, p< .05), childbirth concerns (ß = 0.47, p< .05) and worry about self (ß = 0.74; p< .05) were associated with the intensity of pretraumatic stress disorder symptoms. CONCLUSION This study contributes to the very limited literature on pretraumatic stress symptoms. Thus, it is noteworthy that pretraumatic stress is not a reactivation of a former postpartum PTSD or associated with a prior negative experience of childbirth. Future studies conducted on primiparous women with no history of traumatic exposure could allow to provide additional evidences of the existence of anticipated traumatic reactions of childbirth.
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Affiliation(s)
- Lara Suchanecki
- Department of Psychology, Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers, Poitiers, France
| | - Nelly Goutaudier
- Department of Psychology, Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers, Poitiers, France
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Sandström L, Kaunonen M, Klemetti R, Raussi-Lehto E, Aho AL. Factors helping pregnant multiparas cope with fear of birth: A qualitative study. Midwifery 2023; 125:103803. [PMID: 37659151 DOI: 10.1016/j.midw.2023.103803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE This study describes factors helping pregnant multiparas cope with their fear of birth and aims to contribute insight into measures that could be taken to support and develop care for multiparas with fear of birth. METHODS Purposive sampling was used for collecting data from closed discussion forums. An electronic questionnaire included structured background questions and qualitative open-ended questions related to the factors multiparas had found helped them cope with their fear of birth. After excluding respondents in early pregnancy (n = 20), the data consisted of answers from 78 pregnant multiparas from Finland. The data were analysed using inductive content analysis. RESULTS The factors helping pregnant multiparas to cope with their fear of birth included obtaining information, planning ahead, receiving empathic support, dealing with emotions in different ways, and focusing on the positive. CONCLUSIONS The support multiparas receive for their fear of birth from healthcare providers is insufficient and the quality and content of care varies widely. As a result, multiparas have been left to personally take responsibility for coping with their fear. IMPLICATIONS FOR PRACTICE The care for treating fear of birth in multiparas needs to be improved. This requires a critical evaluation of the maternity system, policies, and competence of healthcare professionals who work with pregnant people.
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Affiliation(s)
- Laura Sandström
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Marja Kaunonen
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland; Pirkanmaa Hospital District, PO BOX 2000 FI-33521 Tampere, Finland
| | - Reija Klemetti
- Department of Knowledge Management and Co-Creation, Finnish Institute for Health and Welfare, Po Box 30, FI-00271 Helsinki, Finland
| | - Eija Raussi-Lehto
- Customer oriented Wellbeing and Health Hub, Metropolia University of Applied Sciences, PO BOX 4000, FI-00079 Metropolia, Helsinki, Finland
| | - Anna Liisa Aho
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
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Beal EM, Slade P, Krahé C. Cognitive processing biases associated with fear of childbirth. J Anxiety Disord 2023; 99:102761. [PMID: 37690358 DOI: 10.1016/j.janxdis.2023.102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
Fear of childbirth (FOC) is a phobic-like response concerning the prospect of giving birth. FOC can have negative implications for women during pregnancy and can impact their birthing experience. Cognitive processing biases (e.g., difficulty disengaging from threatening information, interpreting ambiguous information as threatening, and preferentially recalling threatening content) have previously been found to maintain general anxiety and low mood. To date, there has been no research assessing these attention, interpretation, and memory biases and their relationship with FOC in pregnant women. Accordingly, in this cross-sectional study, participants who were at least 12 weeks pregnant (n = 116), recruited through a local hospital trust, completed tasks assessing attention (emotional Stroop task), interpretation (scrambled sentences test), and explicit memory (recognition task) biases with materials including FOC-related content. They also completed three separate measures of FOC and measures of low mood, general anxiety, worry, and rumination. We found that a negative interpretation bias (but not attention or explicit memory biases) was associated with higher levels of FOC. These findings indicate that women presenting with higher FOC are more likely to demonstrate negative interpretation biases for ambiguous information relating to childbirth, which may inform research developing interventions to support women presenting with FOC.
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Affiliation(s)
- Erin M Beal
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom
| | - Pauline Slade
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom
| | - Charlotte Krahé
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom.
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Varela P, Lykeridou A, Zervas I, Deltsidou A. Psychometric properties of the Greek Version of the Traumatic Event Scale (TES) (Version A) among low-risk pregnant women. BMC Psychol 2023; 11:105. [PMID: 37029446 PMCID: PMC10082481 DOI: 10.1186/s40359-023-01152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND The Traumatic Event Scale (TES) is one of the most often used instruments for the assessment of the Posttraumatic Stress Disorder (PTSD) symptomatology during pregnancy which is linked with adverse effects. The aim of the study was to assess the psychometric properties of the TES (version A) in a sample of Greek pregnant women. METHODS Two hundred one low risk pregnant women in their second or third trimester were invited to participate in the study. Participants completed a number of questionnaires including the Greek versions of TES-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Confirmatory factor analysis (CFA) was conducted in order to test how well the already TES-A five-factor model fits the data from Greece. RESULTS Participants' average age was 34.2 years (SD = 4.3 years). Through CFA the already five-factor structure of the TES-A (Anticipation of trauma, Intrusion, Avoidance, Resignation, Hyperstimulation) was applied to our sample. All five factors were significantly and positively correlated with each other. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. Relatively convergent validity, all factors of the Greek version of the TES-A were significantly associated with stress, anxiety, depression and coping strategies. CONCLUSION The Greek version of TES-A is detected to be a valid and reliable instrument of prenatal Posttraumatic Stress Disorder (PTSD) symptomatology among low-risk Greek pregnant women.
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Affiliation(s)
- Pinelopi Varela
- General Hospital of Athens "Alexandra", Department of Midwifery, University of West Attica, Athens, Greece.
| | | | - Ioannis Zervas
- Professor of Psychiatry and Psychosomatic Medicine, Head of the Women's mental health and reproductive psychiatric clinic, National and Kapodistrian University of Athens Medical School, Eginition University Hospital, Athens, Greece
| | - Anna Deltsidou
- Department of Midwifery, University of West Attica, Athens, Greece
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Rajani F, Vaziri F, Yektatalab S, Sharifi N, Mani A, Akbarzadeh M. The correlation between postpartum stress disorder and maternal anxiety in different types of delivery (vaginal and cesarean section). CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2022. [DOI: 10.15452/cejnm.2022.13.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Saridi M, Toska A, Latsou D, Chondropoulou MA, Matsioula A, Sarafis P. Assessment of quality of life and psycho-emotional burden in pregnant women in Greece. Eur J Midwifery 2022; 6:13. [PMID: 35415465 PMCID: PMC8939182 DOI: 10.18332/ejm/145963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/14/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many changes occur in a woman’s body during pregnancy. These changes (biological, chemical, hormonal, anatomical) can make a pregnant woman both physically and mentally vulnerable. Thus, the aim of this study is to evaluate the quality of life (QoL) in association with depression symptoms in pregnancy. METHODS A cross-sectional study was conducted in 123 pregnant women who visited one of the largest obstetrics and gynecology centers in Greece. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depression symptoms and World Health Organization Quality of Life instrument to evaluate quality of life. The collected data were organized with the SPSS software, version 25. RESULTS The results showed that 15.5% of pregnant women were at an increased risk of developing depression symptoms; 91% of the women declared that their QoL was good/very good, whereas 92.7% was very satisfied with their health status. Depression symptoms seem to be positively correlated with the low household income, unpleasant event during pregnancy, and the trimester of pregnancy. Additionally, unmarried women, an unpleasant event during pregnancy and the second trimester of pregnancy proved to be negatively associated with the quality of life. Women without a risk of depression had better QοL than women who were at risk of depression symptoms. CONCLUSIONS It is important to evaluate the QοL of women during pregnancy with the aim of good prenatal health. The organization of the necessary interventions for mothers’ health and their newborns are also of vital importance.
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Affiliation(s)
- Maria Saridi
- School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Aikaterini Toska
- School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Dimitra Latsou
- Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece
| | | | | | - Pavlos Sarafis
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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The prevalence and predictors of fear of childbirth among pregnant Chinese women: a hierarchical regression analysis. BMC Pregnancy Childbirth 2021; 21:643. [PMID: 34551755 PMCID: PMC8456556 DOI: 10.1186/s12884-021-04123-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background Fear of childbirth (FOC) occurs before, during and after pregnancy and is harmful to both the pregnant woman and the fetus. Identifying the prevalence and predictors of FOC can help us generate strategies for alleviating women’s FOC. Methods A cross-sectional study was conducted among a convenience sample of 646 pregnant women receiving antenatal care at a subordinate hospital of a university in China. Data were collected using a basic information form, the Childbirth Attitude Questionnaire, the Childbirth Self-Efficacy Inventory, and the 10-item Connor-Davidson Resilience Scale. The minimum and maximum total scores of the Childbirth Attitude Questionnaire are 16 and 64, respectively, with higher scores reflecting a greater degree of FOC. We conducted hierarchical regression analysis to explore the predictors of FOC and used a structural equation model to further examine the direct and indirect associations between FOC, resilience and childbirth self-efficacy. Results The total prevalence of FOC was 67.1%. The percentages of women with mild (score of 28–39), moderate (40–51), and severe FOC (52–64) were 45.4, 19.5, and 2.2%, respectively. The average score on the Childbirth Attitude Questionnaire was 32.49, indicating mild FOC. The final regression analysis revealed six variables predicting FOC that explained 64.5% of the variance in FOC: age, gestational age, parity, spousal support, resilience, and childbirth self-efficacy. Furthermore, childbirth self-efficacy mediated the relationship between resilience and FOC, and the mediation effect rate was 53.5%. Conclusions A high prevalence of FOC among pregnant Chinese women was found in this study. Age, gestational age, parity, spousal support, resilience, and childbirth self-efficacy were predictors of FOC. It is suggested that healthcare professionals should pay close attention to FOC and implement targeted interventions in accordance with these predictors, especially resilience and childbirth self-efficacy.
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Davidson AD, Bhat A, Chu F, Rice JN, Nduom NA, Cowley DS. A systematic review of the use of prazosin in pregnancy and lactation. Gen Hosp Psychiatry 2021; 71:134-136. [PMID: 33840480 DOI: 10.1016/j.genhosppsych.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ashley D Davidson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Frances Chu
- University of Washington Health Sciences Library, Seattle, WA, USA
| | - Jessie N Rice
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - N Aba Nduom
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Deborah S Cowley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Abstract
Background Between 5% and 14% of women suffer from fear of childbirth (FOC) which is associated with difficulties during birth and in postnatal psychological adjustment. Therefore, effective interventions are needed to improve outcomes for women. A systematic review and meta-analysis was used to identify effective interventions for treating women with FOC. Methods Literature searches were undertaken on online databases. Hand searches of reference lists were also carried out. Studies were included in the review if they recruited women with FOC and aimed to reduce FOC and/or improve birth outcomes. Data were synthesised qualitatively and quantitatively using meta-analysis. The literature searches provided a total of 4474 citations. Results After removing duplicates and screening through abstracts, titles and full texts, 66 papers from 48 studies were identified for inclusion in the review. Methodological quality was mixed with 30 out of 48 studies having a medium risk of bias. Interventions were categorised into six broad groups: cognitive behavioural therapy, other talking therapies, antenatal education, enhanced midwifery care, alternative interventions and interventions during labour. Results from the meta-analysis showed that most interventions reduced FOC, regardless of the approach (mean effect size = −1.27; z = −4.53, p < 0.0001) and that other talking therapies may reduce caesarean section rates (OR 0.48, 95% CI 0.48–0.90). Conclusions Poor methodological quality of studies limits conclusions that can be drawn; however, evidence suggests that most interventions investigated reduce FOC. Future high-quality randomised controlled trials are needed so that clear conclusions can be made.
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Nath S, Lewis LN, Bick D, Demilew J, Howard LM. Mental health problems and fear of childbirth: A cohort study of women in an inner-city maternity service. Birth 2021; 48:230-241. [PMID: 33733519 DOI: 10.1111/birt.12532] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate the population prevalence of severe fear of childbirth (FOC) during pregnancy and investigate its association with: (a) antenatal common mental disorders (depression and anxiety disorder) and (b) elective cesarean birth. METHODS 545 participants from an inner-city London maternity population were interviewed soon after their first antenatal appointment (mean gestation: 14 weeks). Current mental disorders were assessed using the Structured Clinical Interview DSM-IV. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) at approximately 28 weeks gestation (n = 377), with severe FOC defined using a cutoff of WDEQ-A ≥ 85. Birth mode information was collected at 3 months post-delivery using an adapted Adult Service Use Schedule. Linear regressions were used to model associations, adjusting for the effects of covariates (age, parity, relationship status, education, and planned pregnancy). Sampling weights were used to adjust for bias introduced by the stratified sampling. We also accounted for missing data within the analysis. RESULTS The estimated population prevalence of severe FOC was 3% (95% CI: 2%-6%) (n = 377). Depression and anxiety were significantly associated with severe FOC after adjustment for covariates (45% vs 11%; coefficient: 15.75, 95% CI: 8.08-23.42, P < .001). There was a weak association between severe FOC and elective cesarean birth. CONCLUSIONS Severe FOC occurs in around 3% of the population. Depression and anxiety are associated with FOC. Pregnant people with depression and anxiety may be at increased risk of experiencing severe FOC. Attitudes toward childbirth should be assessed as part of routine clinical assessment of pregnant people in contact with mental health services.
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Affiliation(s)
- Selina Nath
- Health Service and Population Research Department, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy N Lewis
- Health Service and Population Research Department, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jill Demilew
- Women's Health, King's College Hospital NHS Foundation Trust, London, UK
| | - Louise M Howard
- Health Service and Population Research Department, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Wootton BM, Davis E, Moses K, Moody A, Maguire P. The development and initial validation of the Tokophobia Severity Scale. CLIN PSYCHOL-UK 2021. [DOI: 10.1111/cp.12220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Bethany M. Wootton
- Discipline of Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia,
- Department of Medicine (Psychology), University of Tasmania, Hobart, Australia,
| | - Elizabeth Davis
- Anxiety Disorders Center/Center for Cognitive Behavior Therapy, Hartford, Connecticut, USA,
| | - Karen Moses
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia,
| | - Annabelle Moody
- Department of Medicine (Psychology), University of Tasmania, Hobart, Australia,
| | - Peta Maguire
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia,
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Vismara L, Sechi C, Neri M, Paoletti A, Lucarelli L. Maternal perinatal depression, anxiety, fear of birth, and perception of infants' negative affectivity at three months. J Reprod Infant Psychol 2020; 39:532-543. [PMID: 33172285 DOI: 10.1080/02646838.2020.1843612] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The present study aimed to investigate whether a mother's anxiety, depression, prenatal perception of childbirth, and experience with delivery, assessed from pregnancy to three months postpartum, were associated with her perception of her infant's negative affectivity (NA). The participant sample was composed of 76 primiparous mothers and their healthy babies (58% boys, 42% girls). During pregnancy, mothers independently filled out the State-Trait Anxiety Inventory (STAI), the Edinburgh Postnatal Depression Scale (EPDS), and the Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) version A. One month after giving birth, the mothers filled out the W-DEQ version B. Finally, three months after giving birth, they completed the EPDS, the STAI, and the four Infant Behaviour Questionnaire (IBQ-R) scales of NA. Linear regression analyses showed that perinatal FoB, trait anxiety, and depression were associated with a maternal perception of higher infant NA. Studies on perinatal parental health and child outcomes should include assessments of the relation between anxiety during pregnancy and postpartum depression in order to prevent any negative impacts on the temperaments of children.
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Affiliation(s)
- Laura Vismara
- Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Cagliari, Italy
| | - Cristina Sechi
- Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Cagliari, Italy
| | - Manuela Neri
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Anna Paoletti
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Loredana Lucarelli
- Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Cagliari, Italy
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Women's experiences of birth trauma: A scoping review. Women Birth 2020; 34:417-424. [PMID: 33020046 DOI: 10.1016/j.wombi.2020.09.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/09/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND A high number of Australian women report experiencing traumatic birth events. Despite high incidence and potential wide spread and long-lasting effects, birth trauma is poorly recognised and insufficiently treated. Birth trauma can trigger ongoing psychosocial symptoms for women, including anxiety, tokophobia, bonding difficulties, relationship issues and PTSD. Additionally, women's future fertility choices can be inhibited by birth trauma. AIM To summarize the existing literature to provide insight into women's experiences of birth trauma unrelated to a specific pre-existing obstetric or contextual factor. METHODS The review follows 5 stages of Arksey and O'Malley's framework. 7 databases were searched using indexed terms and boolen operators. Data searching identified 1354 records, 5 studies met inclusion criteria. FINDINGS Three key themes emerged; (1) health care providers and the maternity care system. (2) Women's sense of knowing and control. (3) Support. DISCUSSION Continuity of carer creates the foundations for facilitative interactions between care provider and woman which increases the likelihood of a positive birth experience. Women are able to gain a sense of feeling informed and being in control when empowering and individualized care is offered. Functional social supports and forms of debriefing promotes psychological processing and can enable post traumatic growth. CONCLUSION Existing literature highlights how birth trauma is strongly influenced by negative health care provider interactions and dysfunctional operation of the maternity care system. A lack of education and support limited informed decision-making, resulting in feelings of losing control and powerlessness which contributes to women's trauma. Insufficient support further compounds women's experiences.
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Bangma M, Kazemier BM, Papatsonis DNM, Van der Zaag-Loonen HJ, Paarlberg KM. The association between depressive symptoms during pregnancy and post-delivery fear of childbirth; a prospective study. J Reprod Infant Psychol 2020; 38:367-377. [PMID: 32393062 DOI: 10.1080/02646838.2020.1753031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Fear of childbirth is an important reason for a caesarean section on request. OBJECTIVE To assess the association between depressive symptoms during pregnancy and post-delivery fear of childbirth (PFOC). METHODS We prospectively studied pregnant women from two hospitals in the Netherlands. Women completed the Edinburgh Depression Scale (EPDS), the Wijma Delivery Experience Questionnaire (W-DEQ B) and questions concerning risk factors. Depressive symptoms were assessed at baseline and six weeks post-delivery. PFOC was assessed six weeks post-delivery. Baseline characteristics and pregnancy outcomes were compared between women with and without a depression at baseline. The association between depression and PFOC was assessed with multivariable logistic regression analysis. RESULTS 245 women participated in this study. At baseline 11% suffered from depressive symptoms. There were no differences in pregnancy outcomes. Women with depressive symptoms more often suffered from depressive symptoms six weeks post-delivery (adjusted OR 4.9, 95% CI 1.4-17). PFOC six weeks post-delivery was present in 11%. Women with depression were at increased risk of PFOC six weeks post-delivery (adjusted OR 9.2, 95% CI 2.6-32). CONCLUSION This study shows that women with depression at baseline are at increased risk for depression and PFOC six weeks post-delivery.
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Affiliation(s)
- Meike Bangma
- Department of Obstetrics and Gynaecology, Amphia Teaching Hospital Breda , Breda, The Netherlands
| | - Brenda M Kazemier
- Department of Obstetrics and Gynaecology, Gelre Hospitals Apeldoorn Location , Apeldoorn, The Netherlands.,Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam , Amsterdam, The Netherlands
| | - Dimitri N M Papatsonis
- Department of Obstetrics and Gynaecology, Amphia Teaching Hospital Breda , Breda, The Netherlands
| | | | - K Marieke Paarlberg
- Department of Obstetrics and Gynaecology, Gelre Hospitals Apeldoorn Location , Apeldoorn, The Netherlands
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Goutaudier N, Ayache R, Aubé H, Chabrol H. Traumatic anticipation of childbirth and disordered eating during pregnancy. J Reprod Infant Psychol 2020; 38:243-258. [PMID: 32189512 DOI: 10.1080/02646838.2020.1741525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND While research on Fear Of Childbirth (FOC) during pregnancy is on the rise, research regarding pretraumatic stress reactions is lacking. Moreover, less is known regarding negative anticipation of childbirth and Eating Disorders (ED). This study aims at identifying typologies of women in the prepartum period based on FOC and pretraumatic stress symptoms and investigating whether or not the identified profiles differ on levels of bulimic symptoms and Drive for Thinness (DT). PARTICIPANTS AND METHODS a sample of 213 pregnant women completed questionnaires assessing FOC, pretraumatic stress, DT and bulimic symptoms. RESULTS four clusters based on pretraumatic stress and FOC symptoms were identified: one characterised by traumatic symptoms, one showing moderated FOC symptoms, one with high symptomatology and one with low symptoms. Higher ED symptoms were found in women with both FOC and pretraumatic stress symptoms, and in the cluster showing elevated pretraumatic stress symptomatology. CONCLUSIONS To our knowledge, this is the first study focusing on anticipated traumatic reactions and ED in pregnant women. While some women evidenced FOC and pretraumatic stress symptoms, two different clusters, one with FOC and one with pretraumatic stress, were found. These findings suggest that, while sharing similarities, these constructs are different.
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Affiliation(s)
- Nelly Goutaudier
- Centre de Recherches sur la Cognition et l'Apprentissage -UMR CNRS 7295, Université de Poitiers , Poitiers, France
| | - Raphael Ayache
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
| | - Hélène Aubé
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
| | - Henri Chabrol
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse Jean-Jaurès , Toulouse, France
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17
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Gallagher A, Kring D, Whitley T. Effects of yoga on anxiety and depression for high risk mothers on hospital bedrest. Complement Ther Clin Pract 2020; 38:101079. [DOI: 10.1016/j.ctcp.2019.101079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
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18
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Pranal M, Legrand A, de Chazeron I, Llorca PM, Vendittelli F. Prevalence of maternal psychological disorders after immediate postpartum haemorrhage: a repeated cross-sectional study - the PSYCHE* study protoco. BMJ Open 2019; 9:e027390. [PMID: 31488469 PMCID: PMC6731911 DOI: 10.1136/bmjopen-2018-027390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The main objective of this study is to assess the prevalence of depression at 2, 6 and 12 months postpartum in women who have had an immediate postpartum haemorrhage (PPH) (blood loss ≥500 mL within 24 hours of delivery). The secondary objectives are to assess the prevalence of anxiety and post-traumatic stress disorder among these women and to evaluate the prevalence of psychological disorders according to the severity of the PPH. METHODS AND ANALYSIS This repeated, cross-sectional, single-centre study will take place at the Clermont-Ferrand University Hospital (France). The population will comprise a cohort of women giving birth at a term ≥22 weeks of gestation.For each woman with a PPH (exposed), two women without PPH (unexposed) will be included: the women who give birth immediately before and immediately after her. The PPH will be managed according to French guidelines. The principal endpoint is the prevalence of depression, measured by the Edinburgh Postnatal Depression Scale (EPDS). The intervention will consist of four surveys including various self-completed questionnaires: the first during the immediate postpartum (Post-Delivery Perceived Stress Inventory (PDPSI), Spielberger'sState-Trait Anxiety Inventory (STAI)-Y-A and Y-B and Mini-International Neuropsychiatric Interview (M.I.N.I.) 5.0.0), then at 2 months (EPDS, STAI-Y-A, Generalised Anxiety Disorder (GAD-7) and Revised Impact of Event Scale (IES-R)), and finally at 6 months and 1 year postpartum (EPDS, STAI-Y-A, GAD-7, M.I.N.I. 5.0.0 and IES-R). The study will include 1542 women - 514 with PPH. ETHICS AND DISSEMINATION The institutional review board (IRB) approved the study on 14 February 2017 (IRB Sud Est VI: N°AU1243).Results will be reported in peer-reviewed journals and at scientific meetings. Findings from the study will be useful for individualising medical follow-up after childbirth, especially for woman who experienced a PPH, but also more generally in increasing birth professionals' awareness of effects of trauma. The evidence obtained might also lead to modifying practices and including this recommendation in French guidelines on PPH. TRIAL REGISTRATION NUMBER NCT03120208.
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MESH Headings
- Adult
- Anxiety/diagnosis
- Anxiety/epidemiology
- Anxiety/etiology
- Anxiety/physiopathology
- Cross-Sectional Studies
- Delivery, Obstetric/adverse effects
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Depression, Postpartum/diagnosis
- Depression, Postpartum/epidemiology
- Depression, Postpartum/etiology
- Depression, Postpartum/physiopathology
- Female
- France/epidemiology
- Humans
- Parturition/psychology
- Postpartum Hemorrhage/diagnosis
- Postpartum Hemorrhage/psychology
- Prevalence
- Psychiatric Status Rating Scales
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Post-Traumatic/etiology
- Stress Disorders, Post-Traumatic/physiopathology
- Time Factors
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Affiliation(s)
- Marine Pranal
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Anne Legrand
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Ingrid de Chazeron
- Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
- UFR Medecine, EA7280, Univ Clermont 1, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
- UFR Medecine, EA7280, Univ Clermont 1, Clermont-Ferrand, France
| | - Françoise Vendittelli
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
- The AUDIPOG Sentinel Network (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, Lyon, France
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Viswasam K, Eslick GD, Starcevic V. Prevalence, onset and course of anxiety disorders during pregnancy: A systematic review and meta analysis. J Affect Disord 2019; 255:27-40. [PMID: 31129461 DOI: 10.1016/j.jad.2019.05.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anxiety disorders during pregnancy are associated with various adverse outcomes. Previous reviews of anxiety disorders during pregnancy have methodological limitations and were conducted without a meta-analysis. The present study is a systematic review and meta-analysis of the published research on the prevalence, onset and course of all anxiety disorders during pregnancy plus obsessive-compulsive disorder (OCD) and posttraumatic stress disorder. METHODS A comprehensive literature search was performed on a wide range of databases. A random effects model was used for the meta-analysis. RESULTS Thirty-six studies were included. Prevalence rates of anxiety disorders during pregnancy varied considerably. The pooled prevalence rate of each disorder during pregnancy was 3%, except for specific phobia, where it was 6%. Between 13% and 39% of pregnant OCD women had the onset of OCD during pregnancy, and this occurred mainly in the 2nd trimester. The onset of panic disorder (PD) was more common in the 1st and 2nd trimesters of pregnancy. LIMITATIONS Different designs of the included studies, as well as different assessment tools and assessment times during pregnancy and the paucity of studies of the onset and course, preclude definitive conclusions. CONCLUSIONS Anxiety disorders are common during pregnancy. Unlike prevalence rates of other anxiety disorders during pregnancy, prevalence rates of PD and OCD during pregnancy were higher than their lifetime prevalence rates in women in the general population. The onset of OCD during pregnancy is not rare and the course of PD and OCD during pregnancy is highly variable. These findings suggest that pregnancy may be a specific risk factor for the occurrence and/or exacerbation of PD and OCD and underscore the importance of their early diagnosis and management.
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Affiliation(s)
- Kirupamani Viswasam
- Department of Psychiatry, Nepean Hospital, Sydney/Penrith, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Sydney/Penrith, NSW, Australia.
| | - Guy D Eslick
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Sydney/Penrith, NSW, Australia; The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney/Penrith, NSW, Australia
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Sydney/Penrith, NSW, Australia
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20
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Dencker A, Nilsson C, Begley C, Jangsten E, Mollberg M, Patel H, Wigert H, Hessman E, Sjöblom H, Sparud-Lundin C. Causes and outcomes in studies of fear of childbirth: A systematic review. Women Birth 2019; 32:99-111. [DOI: 10.1016/j.wombi.2018.07.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/30/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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21
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Poggi L, Goutaudier N, Séjourné N, Chabrol H. When Fear of Childbirth is Pathological: The Fear Continuum. Matern Child Health J 2019; 22:772-778. [PMID: 29484511 DOI: 10.1007/s10995-018-2447-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Given that prepartum psychiatric symptoms have been reported to be associated with postpartum disorders, focusing on the prepartum period appears of prime importance. The aim of the current study was threefold: (a) to identify the prevalence rates of women suffering from fear of childbirth (FOC) and tokophobia (b) to explore the association between FOC, obstetrical and psychopathological variables and (c) to identify the independent predictors of the intensity of FOC symptoms, FOC and tokophobia. METHODS at 36 weeks' gestation, 98 women completed questionnaires assessing FOC, pretraumatic stress, fear of pain, depressive and anxiety symptomatology as well as perceived social support. Socio-demographic and gynecological data were also gathered. RESULTS 22.45% of women reported a probable FOC and 20.41% suffered from a potential tokophobia. Epidural anesthesia (ß = 5.62, p < 0.05), and the intensity of pretraumatic stress symptoms (ß= 0.69, p < 0.05), were independently associated with the intensity of FOC symptoms. Planning a c-section was significantly related to FOC (β = 0.09, p = 0.03). Planning an epidural anesthesia was also an independent predictor of both FOC and tokophobia (β = 1.33, p = 0.03; β = 1.26, p = 0.04, respectively). CONCLUSIONS Given the high rates of FOC and tokophobia highlighted, developing an appropriate preparation to childbirth is of great relevance. Longitudinal studies should be developed in order to provide an in-depth examination of the course of prepartum psychiatric disorders, maintenance of symptoms and their impact on subsequent infant development.
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Affiliation(s)
- Léa Poggi
- Centre d'Etudes et de Recherches en Psychopathologie et de la Santé - CERPPS (EA 7411), Toulouse Cedex 9, France
| | - Nelly Goutaudier
- Centre de Recherches sur la Cognition et l'Apprentissage -CeRCA- (CNRS, UMR 7295) MSHS - Université de Poitiers, 5 rue Théodore Lefebvre, 86073, Poitiers Cedex 9, France.
| | - Natalène Séjourné
- Centre d'Etudes et de Recherches en Psychopathologie et de la Santé - CERPPS (EA 7411), Toulouse Cedex 9, France
| | - Henri Chabrol
- Centre d'Etudes et de Recherches en Psychopathologie et de la Santé - CERPPS (EA 7411), Toulouse Cedex 9, France
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22
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Hicks LM, Dayton CJ, Victor BG. Depressive and trauma symptoms in expectant, risk-exposed, mothers and fathers: Is mindfulness a buffer? J Affect Disord 2018; 238:179-186. [PMID: 29885607 DOI: 10.1016/j.jad.2018.05.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 04/02/2018] [Accepted: 05/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Perinatal depression is reported in 15-20% of women (Marcus, 2009), 8-16% of men (Paulson and Bazemore, 2010) and low-SES, diverse populations are particularly at risk (Sareen, 2011). Trauma symptoms are commonly comorbid with depression, especially when individuals are exposed to risk factors such as community violence and poverty (Kastello et al., 2015; WenzGross et al., 2016). Parental mental illness places infants at risk for negative outcomes (Junge et al., 2016). Evidence supports that dispositional mindfulness is linked to mental health in many populations, however, a gap lies in the understanding of the relationship between mindfulness, trauma and depression in risk-exposed, pregnant populations, especially with fathers. We hypothesize that dispositional mindfulness is negatively associated with lower depression and trauma symptoms in pregnancy, in mothers and fathers. METHODS Dispositional mindfulness, depressive and trauma symptoms were examined in women and men, exposed to adversity who were expecting a baby (N = 102). Independent t-tests, and bivariate correlations examined the relationships between these variables. Hierarchical regression was utilized to understand how mindfulness and trauma symptoms may contribute to antenatal depression symptoms. RESULTS Significant differences were observed with mindfulness and depressive symptoms, with no differences reported across gender. Mindfulness, depressive and trauma symptoms were associated in the expected directions. Total mindfulness, specifically being non-reactive to one's own thoughts and trauma symptoms predicted depressive symptoms. LIMITATIONS Limitations include small sample size, cross-sectional data and self-report measures. CONCLUSION Mindfulness and trauma symptoms were found to be significant predictors of depressive symptoms in parents-to-be. Those with lower mindfulness exhibited higher levels of depression. These findings may be helpful in disseminated mindfulness-based interventions aimed at treating antenatal depression in both expectant mothers and fathers who are exposed to adversity. Further research is necessary to understand the mechanisms of mindfulness in risk-exposed, expectant parents.
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23
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Goutaudier N, Bertoli C, Séjourné N, Chabrol H. Childbirth as a forthcoming traumatic event: pretraumatic stress disorder during pregnancy and its psychological correlates. J Reprod Infant Psychol 2018; 37:44-55. [DOI: 10.1080/02646838.2018.1504284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nelly Goutaudier
- Centre de Recherches sur la Cognition et l’Apprentissage – CeRCA-UMR CNRS 7295, University of Poitiers, Poitiers, France
| | - Charlene Bertoli
- Centre d’Etudes et de, Recherches en Psychopathologie et Psychologie de la Santé – CERPPS EA 7411, University of Toulouse Jean-Jaurès, Toulouse, France
| | - Natalène Séjourné
- Centre d’Etudes et de, Recherches en Psychopathologie et Psychologie de la Santé – CERPPS EA 7411, University of Toulouse Jean-Jaurès, Toulouse, France
| | - Henri Chabrol
- Centre d’Etudes et de, Recherches en Psychopathologie et Psychologie de la Santé – CERPPS EA 7411, University of Toulouse Jean-Jaurès, Toulouse, France
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24
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Levey EJ, Gelaye B, Koenen K, Zhong QY, Basu A, Rondon MB, Sanchez S, Henderson DC, Williams MA. Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women. Arch Womens Ment Health 2018; 21:193-202. [PMID: 28905129 PMCID: PMC5849493 DOI: 10.1007/s00737-017-0776-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/04/2017] [Indexed: 11/28/2022]
Abstract
Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.
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Affiliation(s)
- Elizabeth J Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
- Institute for Juvenile Research, University of Illinois College of Medicine, Chicago, IL, 60608, USA.
| | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Karestan Koenen
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Qiu-Yue Zhong
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Archana Basu
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | | | - Sixto Sanchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, 02118, USA
- Boston University School of Medicine, Boston, MA, 02118, USA
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25
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Nilsson C, Hessman E, Sjöblom H, Dencker A, Jangsten E, Mollberg M, Patel H, Sparud-Lundin C, Wigert H, Begley C. Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy Childbirth 2018; 18:28. [PMID: 29329526 PMCID: PMC5766978 DOI: 10.1186/s12884-018-1659-7] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/07/2018] [Indexed: 11/22/2022] Open
Abstract
Background Fear of Childbirth (FOC) is a common problem affecting women’s health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings. Methods Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared. Results In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p < 0.0001). Conclusions Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as ‘Are you afraid about the birth?’ In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required. Electronic supplementary material The online version of this article (10.1186/s12884-018-1659-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90, Borås, Sweden. .,Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden.
| | - E Hessman
- Biomedical Library, Gothenburg University Library at University of Gothenburg, Box 416, -405 30, Gothenburg, SE, Sweden
| | - H Sjöblom
- Biomedical Library, Gothenburg University Library at University of Gothenburg, Box 416, -405 30, Gothenburg, SE, Sweden
| | - A Dencker
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - E Jangsten
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - M Mollberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - H Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - C Sparud-Lundin
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - H Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - C Begley
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden.,Chair of Nursing and Midwifery, School of Nursing and Midwifery,Trinity College Dublin, 24, D'Olier St. Dublin 2, Dublin, Ireland
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Geller PA, Stasko EC. Effect of Previous Posttraumatic Stress in the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2017; 46:912-922. [PMID: 28667832 DOI: 10.1016/j.jogn.2017.04.136] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To review the extant literature on the effect of traumatic experiences that pre-date conception, pregnancy, and the postpartum period (perinatal period) and present a thematic overview of current issues in this relatively new area of inquiry. DATA SOURCES Electronic databases Cochrane, CINAHL, PsychINFO, and PubMed were searched. Manual searches of reference lists supplemented the electronic search. STUDY SELECTION Peer-reviewed articles written in English on the role of posttraumatic stress disorder during the perinatal period were included. DATA EXTRACTION Key findings relevant to perinatal posttraumatic stress that were reported in primary sources and meta-analyses were organized according to themes, including The Role of Childbirth, Comorbidity With Depression and Anxiety, Risk Factors for Perinatal PTSD, High-Risk Health Behaviors, and Association With Adverse Health Outcomes. DATA SYNTHESIS Across studies, antenatal posttraumatic stress disorder (PTSD) rates were estimated between 2.3% and 24%, and observed prevalence rates during the postnatal period ranged from 1% to 20%; however, many researchers failed to assess PTSD that existed before or during pregnancy, and when preexisting PTSD is a controlled variable, postpartum rates drop to 2% to 4.7%. In addition to prenatal depression and anxiety and pre-pregnancy history of psychiatric disorders, history of sexual trauma, childhood sexual abuse, intimate partner violence, and psychosocial attributes are risk factors for development or exacerbation of perinatal PTSD. CONCLUSION Women's health care providers should evaluate for PTSD in routine mental health assessments during and after pregnancy, especially with a reported history of trauma or the presence of a mood or anxiety disorder. Such screening will allow women to receive needed treatment and referrals and mitigate the potentially negative sequelae of PTSD. Future investigators must recognize the importance of subsyndromal posttraumatic stress symptoms and individual differences in responses to trauma.
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Nieminen K, Wijma K, Johansson S, Kinberger EK, Ryding EL, Andersson G, Bernfort L, Wijma B. Severe fear of childbirth indicates high perinatal costs for Swedish women giving birth to their first child. Acta Obstet Gynecol Scand 2017; 96:438-446. [DOI: 10.1111/aogs.13091] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Katri Nieminen
- Unit of Medical Psychology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
- Department of Obstetrics and Gynecology; Vrinnevisjukhuset; Region Council of Östergötland; Norrköping Sweden
| | - Klaas Wijma
- Unit of Medical Psychology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Sanna Johansson
- Unit of Medical Psychology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Emelie K. Kinberger
- Unit of Medical Psychology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Elsa-Lena Ryding
- Division of Obstetrics and Gynecology; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning; Linköping University; Linköping Sweden
- Division of Psychiatry; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Lars Bernfort
- Division of Health Care Analysis; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Barbro Wijma
- Unit of Gender and Medicine; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
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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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Nieminen K, Andersson G, Wijma B, Ryding EL, Wijma K. Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study. J Psychosom Obstet Gynaecol 2016; 37:37-43. [PMID: 26918752 DOI: 10.3109/0167482x.2016.1140143] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the present study was to test the feasibility of Internet interventions among nulliparous women suffering from severe fear of childbirth (FOC) by means of an Internet-delivered therapist-supported self-help program based on cognitive behavioral therapy (ICBT). DESIGN Prospective, longitudinal cohort study. SETTING A feasibility study of an ICBT program for the treatment of severe FOC in pregnant women. SAMPLE Twenty-eight Swedish-speaking nulliparous women with severe FOC recruited via a project home page from January 2012 to December 2013. METHODS The main components of the ICBT program for the treatment of severe FOC comprised psycho-education, breathing retraining, cognitive restructuring, imaginary exposure, in vivo exposure and relapse prevention. The study participants were anonymously self-recruited over the Internet, interviewed by telephone and then enrolled. All participants were offered 8 weeks of treatment via the Internet. Participants reported their homework weekly, submitted measurements of their fear and received feedback from a therapist via a secure online contact management system. MAIN OUTCOME MEASURES Level of FOC measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) during screening at enrollment and weekly during the treatment (W-DEQ version A), and after the delivery (W-DEQ version B). RESULTS A statistically significant (p < 0.0005) decrease of FOC [W-DEQ sum score decreased pre to post-therapy, with a large effect size (Cohen's d = 0.95)]. CONCLUSIONS The results of this feasibility study suggest that ICBT has potential in the treatment of severe FOC during pregnancy in motivated nulliparous women. The results need to be confirmed by randomized controlled studies.
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Affiliation(s)
- Katri Nieminen
- a Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences , Linköping University , Linköping , Sweden .,b Department of Obstetrics and Gynaecology , Vrinnevi Hospital , Norrköping , Sweden
| | - Gerhard Andersson
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden .,d Department of Clinical Neuroscience , Division of Psychiatry, Karolinska Institutetet , Stockholm , Sweden
| | - Barbro Wijma
- e Unit of Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences , Linköping University , Linköping , Sweden , and
| | - Elsa-Lena Ryding
- f Department of Women's and Children's Health , Division of Obstetrics and Gynaecology, Karolinska Institutet , Stockholm , Sweden
| | - Klaas Wijma
- a Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences , Linköping University , Linköping , Sweden
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Rondung E, Thomtén J, Sundin Ö. Psychological perspectives on fear of childbirth. J Anxiety Disord 2016; 44:80-91. [PMID: 27788373 DOI: 10.1016/j.janxdis.2016.10.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/22/2016] [Accepted: 10/13/2016] [Indexed: 11/27/2022]
Abstract
The objective of this narrative review was to examine the literature on fear of childbirth from a psychological perspective, addressing the specificity of childbirth fear, the pathways of fear acquisition, and the physiological, cognitive and behavioral aspects of fear. Systematic procedures for literature search, inclusion and exclusion left 86 original research papers for analysis. Findings summarize the body of knowledge for each area of interest, as well as the number of studies addressing each theme. Overall, few studies adopt a clear-cut psychological perspective, leaving the psychological mechanisms of childbirth fear largely unexplored. Although methodological limitations make conclusions difficult, results give a hint of etiological diversity and possible psychological mechanisms commonly described as transdiagnostic features in anxiety. Systematic investigations of psychological mechanisms, longitudinal studies exploring possible vicious circles of fear, and studies comparing psychological characteristics within the group of women fearing childbirth are identified as research areas of high priority.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| | - Johanna Thomtén
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
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Twohig MP, O'Donohue WT. Treatment of Posttraumatic Stress Disorder with Exposure Therapy During Late Term Pregnancy. Clin Case Stud 2016. [DOI: 10.1177/1534650107296804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper illustrates the treatment of posttraumatic stress disorder (PTSD), with exposure therapy, on a woman who was in later term pregnancy. The client was successfully treated in 14 sessions with no reported complications to the health of the client or the fetus. Two-month follow-up data showed continued improvement on PTSD symptomatology. The delivery was without complications and the mother and the infant were in good health. Recommendations for treatment of pregnant clients are provided.
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Nieminen K, Berg I, Frankenstein K, Viita L, Larsson K, Persson U, Spånberger L, Wretman A, Silfvernagel K, Andersson G, Wijma K. Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial. Cogn Behav Ther 2016; 45:287-306. [PMID: 27152849 DOI: 10.1080/16506073.2016.1169626] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale-Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.
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Affiliation(s)
- Katri Nieminen
- a Faculty of Medicine and Health Sciences, Unit of Medical Psychology, Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.,b Department of Obstetrics and Gynaecology , Vrinnevisjukhuset , County Council of Östergötland, Norrköping , Sweden
| | - Ida Berg
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Katri Frankenstein
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Lina Viita
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Kamilla Larsson
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Ulrika Persson
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Loviisa Spånberger
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Anna Wretman
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Kristin Silfvernagel
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Gerhard Andersson
- c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.,d Department of Clinical Neuroscience, Division of Psychiatry , Karolinska Institutet , Stockholm , Sweden
| | - Klaas Wijma
- a Faculty of Medicine and Health Sciences, Unit of Medical Psychology, Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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Agius A, Xuereb RB, Carrick-Sen D, Sultana R, Rankin J. The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: A systematic review. Midwifery 2016; 36:70-9. [PMID: 27106946 DOI: 10.1016/j.midw.2016.02.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 01/28/2016] [Accepted: 02/22/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE to identify and appraise the current international evidence regarding the presence and prevalence of the co-existence of depression, anxiety and post-traumatic stress symptoms in the antenatal and post partum period. METHODS using a list of keywords, Medline, CINHAL, Cochrane Library, EMBASE, PsychINFO, Web of Science and the Index of Theses and Conference Proceedings (Jan 1960 - Jan 2015) were systematically searched. Experts in the field were contacted to locate papers that were in progress or in press. Reference lists from relevant review articles were searched. Inclusion criteria included full papers published in English reporting concurrent depression, anxiety and post-traumatic stress symptoms in pregnant and post partum women. A validated data extraction review tool was used. FINDINGS 3424 citations were identified. Three studies met the full inclusion criteria. All reported findings in the postnatal period. No antenatal studies were identified. The prevalence of triple co-morbidity was relatively low ranging from 2% to 3%. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE triple co-morbidity does occur, although the prevalence appears to be low. Due to the presentation of complex symptoms, women with triple co-morbidity are likely to be difficult to identify, diagnose and treat. Clinical staff should be aware of the potential of complex symptomatology.
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Affiliation(s)
- Andee Agius
- Department of Obstetrics and Gynaecology, Malta Mater Dei Hospital, Dun Karm Street, Msida MSD 2090, Malta.
| | - Rita Borg Xuereb
- Faculty of Health Sciences, Mater Dei Hospital, Room 34, Block A, Level 1, Msida MSD 2090, Malta.
| | - Debbie Carrick-Sen
- Nursing Department, School of Medical and Dental Sciences, University of Birmingham, Room EF14, Birmingham, United Kingdom.
| | - Roberta Sultana
- Department of Occupational Therapy, St.Vincent de Paul, Malta.
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Baddiley-Clarke Building, Richardson Road, Newcastle upon Tyne NE2 4AX, United Kingdom.
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Gosselin P, Chabot K, Béland M, Goulet-Gervais L, Morin AJS. [Fear of childbirth among nulliparous women: Relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms]. Encephale 2016; 42:191-6. [PMID: 26924001 DOI: 10.1016/j.encep.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Fear of childbirth is common in women who are pregnant with their first child and is associated with important consequences such as abortions and miscarriages. Twenty percent of nulliparous women seem to exhibit a mild or moderate fear, while 6% present an excessive and irrational fear known as tocophobia. Tocophobia is suggested to be associated with many negative consequences such as postpartum depression (PPD) and Post-traumatic stress (PTS). However, there is little empirical evidence to support these relationships. Recently, Fairbrother and Woody (2007) did not observe a link between the fear of childbirth and symptoms of PPD and PTS in nulliparous women. Some results, near the significance level, could be explained by a lack of statistical power. The present study focused on the link between the fear of childbirth and the process of delivery, the perception of pain, PPD and PTS. More specifically, it aimed to test three hypotheses: (i) fear of childbirth will be linked to the process of delivery, especially regarding the perception of pain, the use of anaesthesia and the use of Caesarean section; (ii) a high level of fear of childbirth will be associated with more negative postpartum consequences (namely PPD/PTS symptoms); (iii) the process of delivery and pain will also be related to post-delivery symptoms. Mediation effects were tested. METHOD Data from a longitudinal study were used to meet the hypotheses. A total of 176 nulliparous pregnant women responded to questionnaires at two time measurements (during pregnancy and at 5weeks postpartum). RESULTS Fear of childbirth is related to the perception of pain at birth among women delivering vaginally, in the absence of anaesthesia. It is also linked to symptoms of PPD and PTS, regardless of whether or not anaesthesia was used. Fear of childbirth also appears to be strongly associated to symptoms of PTS in women who have experienced an unplanned caesarean section. Thus, symptoms of postpartum PTS could play a mediating role in the link between fear of childbirth and PPD. CONCLUSIONS These results support the relevance of taking into account the fear of childbirth and perception of pain in connection with symptoms of PTS and PPD in nulliparous women. The unplanned caesarean section (including emergency caesarean) also appears to be important in the study of the relationship between fear and symptoms of PTS. Fear of childbirth could render the experience of childbearing more negative and predispose to PTS and PPD. Enabling psychological vulnerabilities could also be an interesting avenue for understanding these links. Limitations are discussed.
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Affiliation(s)
- P Gosselin
- Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada.
| | - K Chabot
- Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - M Béland
- Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - L Goulet-Gervais
- Département de psychologie, université de Sherbrooke, Institut universitaire de première ligne en santé et services sociaux - Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - A J S Morin
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australie
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Størksen HT, Garthus-Niegel S, Adams SS, Vangen S, Eberhard-Gran M. Fear of childbirth and elective caesarean section: a population-based study. BMC Pregnancy Childbirth 2015; 15:221. [PMID: 26382746 PMCID: PMC4573308 DOI: 10.1186/s12884-015-0655-4] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This population-based cohort study aimed to investigate the demographic and psychosocial characteristics associated with fear of childbirth and the relative importance of such fear as a predictor of elective caesarean section. METHODS A sample of 1789 women from the Akershus Birth Cohort in Norway provided data collected by three self-administered questionnaires at 17 and 32 weeks of pregnancy and 8 weeks postpartum. Information about the participants' childbirths was obtained from the hospital records. RESULTS Eight percent of the women reported fear of delivery, defined as a score of ≥85 on the Wijma Delivery Expectancy Questionnaire. Using multivariable logistic regression models, a previous negative overall birth experience exerted the strongest impact on fear of childbirth, followed by impaired mental health and poor social support. Fear of childbirth was strongly associated with a preference for elective caesarean section (aOR 4.6, 95% CI 2.9-7.3) whereas the association of fear with performance of caesarean delivery was weaker (aOR 2.4, 95% CI 1.2-4.9). The vast majority (87%) of women with fear of childbirth did not, however, receive a caesarean section. By contrast, a previous negative overall birth experience was highly predictive of elective caesarean section (aOR 8.1, 95% CI 3.9-16.7) and few women without such experiences did request caesarean section. CONCLUSIONS Results suggest that women with fear of childbirth may have identifiable vulnerability characteristics, such as poor mental health and poor social support. Results also emphasize the need to focus on the subjective experience of the birth to prevent fear of childbirth and elective caesarean sections on maternal request. Regarding the relationship with social support, causality has to be interpreted cautiously, as social support was measured at 8 weeks postpartum only.
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Affiliation(s)
- Hege Therese Størksen
- Health Services Research Centre, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany. .,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Samantha S Adams
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway.
| | - Siri Vangen
- Norwegian Resource Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway. .,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Malin Eberhard-Gran
- Health Services Research Centre, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway. .,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
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Fontein-Kuipers Y, Ausems M, Budé L, Van Limbeek E, De Vries R, Nieuwenhuijze M. Factors influencing maternal distress among Dutch women with a healthy pregnancy. Women Birth 2015; 28:e36-43. [DOI: 10.1016/j.wombi.2015.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 01/19/2023]
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Wosu AC, Gelaye B, Williams MA. Childhood sexual abuse and posttraumatic stress disorder among pregnant and postpartum women: review of the literature. Arch Womens Ment Health 2015; 18:61-72. [PMID: 25380784 PMCID: PMC4308508 DOI: 10.1007/s00737-014-0482-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/18/2014] [Indexed: 11/29/2022]
Abstract
The aims of this review are (i) to summarize and evaluate current knowledge on the association between childhood sexual abuse (CSA) and posttraumatic stress disorder (PTSD) in pregnant and postpartum women, (ii) to provide suggestions for future research on this topic, and (iii) to highlight some clinical implications. Relevant publications were identified through literature searches of four databases (PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and PsycARTICLES) using keywords such as "child abuse," "posttraumatic stress," "pregnancy," and "postpartum". Five studies were included in this review. Findings across all studies were consistent with higher prevalence of PTSD diagnosis or symptomatology among women with history of CSA. However, only findings from two studies were statistically significant. One study observed higher overall PTSD scores in women with CSA history compared to women with non-CSA trauma history or no trauma history during pregnancy (mean ± SD 1.47 (0.51) vs. 1.33 (0.41) vs. 1.22 (0.29), p < 0.001), at 2 months postpartum (mean ± SD 1.43 (0.49) vs. 1.26 (0.38) vs. 1.19 (0.35), p < 0.001), and at 6 months postpartum (mean ± SD 1.36 (1.43) vs. 1.20 (0.33) vs. 1.14 (0.27), p < 0.001). Another study observed that the prevalence of PTSD during pregnancy was 4.1 % in women with no history of physical or sexual abuse, 11.4 % in women with adult physical or sexual abuse history, 16.0 % in women with childhood physical or sexual abuse history, and 39.0 % in women exposed to both childhood and adult physical or sexual abuse (p < 0.001); in a subsequent analysis, the investigators reported that pregnant women with PTSD had over 5-fold odds of having a history of childhood completed rape compared to counterparts without PTSD (OR = 5.3, 95 % CI 3.2, 8.7). Overall, available evidence suggests positive associations of CSA with clinical PTSD or PTSD symptomatology among pregnant and postpartum women.
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Affiliation(s)
- Adaeze C. Wosu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - Michelle A. Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
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Newham JJ, Wittkowski A, Hurley J, Aplin JD, Westwood M. Effects of antenatal yoga on maternal anxiety and depression: a randomized controlled trial. Depress Anxiety 2014; 31:631-40. [PMID: 24788589 DOI: 10.1002/da.22268] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/27/2014] [Accepted: 03/01/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antenatal depression and anxiety are associated with adverse obstetric and mental health outcomes, yet practicable nonpharmacological therapies, particularly for the latter, are lacking. Yoga incorporates relaxation and breathing techniques with postures that can be customized for pregnant women. This study tested the efficacy of yoga as an intervention for reducing maternal anxiety during pregnancy. METHODS Fifty-nine primiparous, low-risk pregnant women completed questionnaires assessing state (State Trait Anxiety Inventory; STAI-State), trait (STAI-Trait), and pregnancy-specific anxiety (Wijma Delivery Expectancy Questionnaire; WDEQ) and depression (Edinburgh Postnatal Depression Scale; EPDS) before randomization (baseline) to either an 8-week course of antenatal yoga or treatment-as-usual (TAU); both groups repeated the questionnaires at follow-up. The yoga group also completed pre- and postsession state anxiety and stress hormone assessments at both the first and last session of the 8-week course. RESULTS A single session of yoga reduced both subjective and physiological measures of state anxiety (STAI-S and cortisol); and this class-induced reduction in anxiety remained at the final session of the intervention. Multiple linear regression analyses identified allocation to yoga as predictive of greater reduction in WDEQ scores (B = -9.59; BCa 95% CI = -18.25 to -0.43; P = .014; d = -0.57), while allocation to TAU was predictive of significantly increased elevation in EPDS scores (B = -3.06; BCa 95% CI = -5.9 to -0.17; P = .042; d = -0.5). No significant differences were observed in state or trait anxiety scores between baseline and follow-up. CONCLUSION Antenatal yoga seems to be useful for reducing women's anxieties toward childbirth and preventing increases in depressive symptomatology.
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Affiliation(s)
- James J Newham
- Maternal and Fetal Health Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Maternal and Fetal Health Research Centre, Manchester Academic Health Sciences Centre, St Mary's Hospital Central Manchester Universities NHS Foundation Trust, Manchester, UK
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Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clin Psychol Rev 2014; 34:389-401. [DOI: 10.1016/j.cpr.2014.05.003] [Citation(s) in RCA: 381] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 05/01/2014] [Accepted: 05/18/2014] [Indexed: 01/12/2023]
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Paschetta E, Berrisford G, Coccia F, Whitmore J, Wood AG, Pretlove S, Ismail KMK. Perinatal psychiatric disorders: an overview. Am J Obstet Gynecol 2014; 210:501-509.e6. [PMID: 24113256 DOI: 10.1016/j.ajog.2013.10.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 01/10/2023]
Abstract
Perinatal mental illness has a significant implication on maternal health, birth outcomes, and the offspring's development. Prevalence estimates of perinatal psychiatric illnesses range widely, with substantial heterogeneity in different population studies, with a lower prevalence rate in high- rather than low- or middle-income countries. Because of the potential negative impact on maternal and child outcomes and the potential lability of these disorders, the perinatal period is a critical time to identify psychiatric illnesses. Thus, obstetricians and midwives play a crucial role in assessing women's mental health needs and to refer identified women promptly for multidisciplinary specialist assessment. However, there is still limited evidence on best practice assessment and management policies during pregnancy and postpartum. This review focuses on the prevalence of common perinatal mental disorders and antenatal screening policies to identify women at risk. The effect of these conditions and their management on pregnancy, fetal outcomes, and child development are discussed.
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Affiliation(s)
- Elena Paschetta
- Birmingham Women's National Health Service Foundation Trust, Birmingham, UK
| | - Giles Berrisford
- Perinatal Mental Health Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Floriana Coccia
- Perinatal Mental Health Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Jennifer Whitmore
- Perinatal Mental Health Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Amanda G Wood
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Sam Pretlove
- Birmingham Women's National Health Service Foundation Trust, Birmingham, UK
| | - Khaled M K Ismail
- Birmingham Women's National Health Service Foundation Trust, Birmingham, UK; School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Taghizadeh Z, Arbabi M, Kazemnejad A, Irajpour A, Lopez V. Iranian mothers' perceptions of the impact of the environment on psychological birth trauma: A qualitative study. Int J Nurs Pract 2014; 21 Suppl 2:58-66. [DOI: 10.1111/ijn.12286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ziba Taghizadeh
- Nursing and Midwifery School; Tehran University of Medical Sciences; Tehran Iran
- Nursing and Midwifery Care Research Center; Isfahan University of Medical Sciences; Isfahan Iran
| | - Mohammad Arbabi
- Psychiatry and Psychology Research Center; Tehran University of Medical Sciences; Tehran Iran
| | | | - Alireza Irajpour
- Nursing and Midwifery Care Research Center; Isfahan University of Medical Sciences; Isfahan Iran
| | - Violeta Lopez
- Research Centre for Nursing and Midwifery Practice, Medical School; Australian National University Woden; Australian Capital Territory Australia
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Garthus-Niegel S, Knoph C, von Soest T, Nielsen CS, Eberhard-Gran M. The role of labor pain and overall birth experience in the development of posttraumatic stress symptoms: a longitudinal cohort study. Birth 2014; 41:108-15. [PMID: 24654643 DOI: 10.1111/birt.12093] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this prospective study was to investigate the role of labor pain and overall birth experience in the development of posttraumatic stress symptoms in a comprehensive framework. METHODS The study sample (N = 1893) comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort, which targeted all women scheduled to give birth at Akershus University Hospital in Norway. Questionnaires were given at three different stages: from pregnancy weeks 17 to 32, from the maternity ward, and from 8 weeks postpartum. Data were also obtained from the hospital's birth record. Using structural equation modeling, a prospective mediation model was tested. RESULTS Posttraumatic stress symptoms were significantly related to both labor pain (r = 0.23) and overall birth experience (r = 0.39). A substantial portion (33%) of the effect of labor pain on posttraumatic stress symptoms was mediated by the overall birth experience. CONCLUSIONS Although the results of this study showed that both labor pain and overall birth experience played a role in the development of posttraumatic stress symptoms after childbirth, overall birth experience appeared to be the central factor. The women's birth experience was not only related to posttraumatic stress symptoms directly but also mediated a substantial portion of the effect of labor pain on posttraumatic stress symptoms. Future work should address which areas of birth experience confer protective effects on women to improve clinical care.
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Affiliation(s)
- Susan Garthus-Niegel
- TU Dresden and at the Department of Psychosomatics and Health Behavior, Institute and Outpatient Clinics of Occupational and Social Medicine, Norwegian Institute of Public Health, Oslo, Norway
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The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study. Arch Womens Ment Health 2013; 16:1-10. [PMID: 22940723 DOI: 10.1007/s00737-012-0301-3] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 08/07/2012] [Indexed: 10/27/2022]
Abstract
The aim of this prospective study was to examine the etiology of post-traumatic stress symptoms following childbirth within a transactional framework of stress. Participants were women (N = 1,499) from the Akershus Birth Cohort. These women were followed from pregnancy to 8 weeks postpartum. We modeled predisposing factors (e.g., fear of childbirth) and precipitating factors (subjective and objective birth experiences) as predictors of post-traumatic stress symptoms. Post-traumatic stress symptoms were measured by means of the Impact of Event Scale, objective birth experiences by means of birth journals, and subjective birth experiences by means of three questions. A structural equation model showed that subjective birth experiences had the highest association with post-traumatic stress symptoms. Moreover, they mediated the effect of predisposing factors and objective birth experiences. The results suggest that women's subjective birth experiences are the most important factor in the development of post-traumatic stress symptoms following childbirth.
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Wangel AM, Schei B, Ryding EL, Ostman M. Mental health status in pregnancy among native and non-native Swedish-speaking women: a Bidens study. Acta Obstet Gynecol Scand 2012; 91:1395-401. [PMID: 22881599 DOI: 10.1111/j.1600-0412.2012.01512.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe mental health status in native and non-native Swedish-speaking pregnant women and explore risk factors of depression and posttraumatic stress (PTS) symptoms. DESIGN AND SETTING A cross-sectional questionnaire study was conducted at midwife-based antenatal clinics in Southern Sweden. SAMPLE A non-selected group of women in mid-pregnancy. METHODS Participants completed a questionnaire covering background characteristics, social support, life events, mental health variables and the short Edinburgh Depression Scale. MAIN OUTCOME MEASURES Depressive symptoms during the past week and PTS symptoms during the past year. RESULTS Out of 1003 women, 21.4% reported another language than Swedish as their mother tongue and were defined as non-native. These women were more likely to be younger, have fewer years of education, potential financial problems, and lack of social support. More non-native speakers self-reported depressive, PTS, anxiety and, psychosomatic symptoms, and fewer had had consultations with a psychiatrist or psychologist. Of all women, 13.8% had depressive symptoms defined by Edinburgh Depression Scale 7 or above. Non-native status was associated with statistically increased risks of depressive symptoms and having ≥1 PTS symptom compared with native-speaking women. Multivariate modeling including all selected factors resulted in adjusted odds ratios for depressive symptoms of 1.75 (95% confidence interval: 1.11-2.76) and of 1.56 (95% confidence interval: 1.10-2.34) for PTS symptoms in non-native Swedish speakers. CONCLUSION Non-native Swedish-speaking women had a more unfavorable mental health status than native speakers. In spite of this, non-native speaking women had sought less mental health care.
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Béland M, Chabot K, Goulet Gervais L, Morin A, Gosselin P. Évaluation de la peur de l’accouchement. Validation et adaptation française d’une échelle mesurant la peur de l’accouchement. Encephale 2012; 38:336-44. [DOI: 10.1016/j.encep.2011.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 06/16/2011] [Indexed: 10/15/2022]
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Anxiety and fear of childbirth as predictors of postnatal depression in nulliparous women. Women Birth 2012; 25:e37-43. [DOI: 10.1016/j.wombi.2011.09.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 09/01/2011] [Accepted: 09/02/2011] [Indexed: 11/21/2022]
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Sluijs AM, Cleiren MPHD, Scherjon SA, Wijma K. No relationship between fear of childbirth and pregnancy-/delivery-outcome in a low-risk Dutch pregnancy cohort delivering at home or in hospital. J Psychosom Obstet Gynaecol 2012; 33:99-105. [PMID: 22621317 DOI: 10.3109/0167482x.2012.685905] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the relationship of fear of childbirth (FOC), general anxiety and depression during pregnancy and postpartum with birth complications. METHODS For this prospective cohort study 105 healthy women with low-risk pregnancies (until at least 30 weeks gestation) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and the Hospital Anxiety and Depression Scale (HADS) at 30 weeks gestation and 6 weeks postpartum. These results were related with delivery characteristics. RESULTS FOC during pregnancy was not related to complications during labour and delivery. In a regression analysis, both multiparity and medical interventions were predictors for higher postpartum FOC. A positive correlation was found between FOC during pregnancy and FOC at six weeks postpartum, corrected for complications during childbirth (r = 0.45, p < 0.001). CONCLUSIONS The birth giving process was not related to FOC during pregnancy, but the pre-partum level of FOC certainly is predictive of the level of postpartum FOC, suggesting that FOC as measured during gestation may influence the interpretation of the birth experience itself. We did find a positive relationship between both parity and medical interventions during childbirth and FOC postpartum.
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Affiliation(s)
- Anne-Marie Sluijs
- Leiden University Medical Centre, Obstetrics, Albinusdreef 2, Leiden, Netherlands.
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Dale-Hewitt V, Slade P, Wright I, Cree M, Tully C. Patterns of attention and experiences of post-traumatic stress symptoms following childbirth: an experimental study. Arch Womens Ment Health 2012; 15:289-96. [PMID: 22688919 DOI: 10.1007/s00737-012-0290-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 05/28/2012] [Indexed: 11/29/2022]
Abstract
Childbirth for some women can be experienced as a traumatic event whereby it is appraised as threatening to life and associated with feelings of fear, helplessness or horror. These women may develop symptoms consistent with post-traumatic stress disorder or its sub-clinical symptoms (post-traumatic stress, PTS). Cognitive processes such as attentional biases have been identified in individuals with PTS exposed to other traumatic events. This study used an experimental design (the modified Stroop task) to investigate the relationship between attentional biases and PTS symptoms in 50 women who experienced their labour and delivery as stressful and responded with fear, helplessness and horror. Attentional biases away from childbirth words were significantly associated with both symptoms of post-traumatic stress and more negative experiences of childbirth. A negative experience was also associated with more severe symptoms of PTS. Positive experiences were unassociated with attentional biases or symptoms. Post-traumatic stress responses, in this population, may be associated with avoidance, and through influencing cognitive processing, acting as a maintaining factor of distress.
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Dailey DE, Humphreys JC, Rankin SH, Lee KA. An exploration of lifetime trauma exposure in pregnant low-income African American women. Matern Child Health J 2011; 15:410-8. [PMID: 18253820 PMCID: PMC3150846 DOI: 10.1007/s10995-008-0315-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 01/22/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The objective of this study was to describe the occurrence of lifetime trauma exposure in relation to perinatal health outcomes in low-income African American women. METHODS One hundred and sixteen pregnant African American women recruited from two public prenatal clinics participated in this exploratory study. Information was obtained about psychological symptoms, medical conditions, prenatal care utilization, and health behaviors. To measure lifetime trauma exposure, women completed the Trauma History Questionnaire. Maternal and infant outcome data were obtained from the medical records following delivery. RESULTS The occurrence of trauma exposure was high, with 87% of the women reporting at least one traumatic event. Their mean age was 25 years, 21% were primiparas, and they reported a mean of 4.3 ± 3.5 (median = 3) traumatic events during their lifetime. Crime-related experiences were common and included incidents of family or friends being murdered or killed (40%), robberies (23%), home burglaries (14%), attacks with weapons (13%), and muggings (12%). Lifetime trauma exposure was significantly associated with depressive symptoms, anxiety, and generalized stress. Women with greater lifetime trauma exposure had a higher rate of tobacco use, higher rate of premature rupture of membranes, and longer maternal hospital stay. CONCLUSION Low-income African American women in this sample experienced a variety of traumatic events. Lifetime trauma exposure was associated with adverse perinatal health. Findings suggest the need to further investigate trauma across the lifespan to better understand the impact of these experiences on the reproductive health and well-being of women and their infants.
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Affiliation(s)
- Dawn E Dailey
- Family, Maternal & Child Health Programs, Department of Public Health, Contra Costa Health Services, 597 Center Avenue, Martinez, CA, USA.
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Zlotnick C, Capezza NM, Parker D. An interpersonally based intervention for low-income pregnant women with intimate partner violence: a pilot study. Arch Womens Ment Health 2011; 14:55-65. [PMID: 21153559 PMCID: PMC3042850 DOI: 10.1007/s00737-010-0195-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 11/02/2010] [Indexed: 11/29/2022]
Abstract
This study assessed the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing depression and posttraumatic stress disorder (PTSD) in a sample of low-income pregnant women with recent intimate partner violence (IPV). Fifty-four women were randomly assigned to the intervention or control group. The intervention consisted of four sessions during pregnancy and one "booster" session within 2 weeks of delivery. Based on principles of Interpersonal Psychotherapy, the intervention was designed to help participants improve their interpersonal relationships, including their social support networks, and master their role transition to motherhood. Assessments were administered at four time points (intake, 5-6 weeks post-intake, 2 weeks postpartum, 3 months postpartum) to assess for depression, PTSD, and IPV. The intervention did not significantly reduce the likelihood of a major depressive episode, PTSD, or IPV during pregnancy or up to 3-month postpartum. However, we found moderate effects for the intervention in reducing symptoms of PTSD and depression during pregnancy and a large effect for PTSD symptoms from pregnancy up to 3 months postpartum. This study suggests some initial support for our intervention. Larger randomized trials are needed to further examine the intervention both during and after pregnancy.
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Affiliation(s)
- Caron Zlotnick
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
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