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Gilbert L, Sandoz V, Deforges C, Horsch A. A two-item screening of maternal or infant perceived life threat during childbirth prospectively associated with childbirth-related posttraumatic stress symptoms up to six months postpartum: two observational longitudinal studies. Front Psychiatry 2024; 15:1360189. [PMID: 38654730 PMCID: PMC11036539 DOI: 10.3389/fpsyt.2024.1360189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Objective This study investigated prospective relationships between the perception of threat to one's own life or to that of one's infant during childbirth and maternal childbirth-related posttraumatic stress symptoms (CB-PTSS) and probable childbirth-related posttraumatic stress disorder (CB-PTSD) in a community and a community and an emergency cesarean section (ECS) sample. Methods Study samples included 72 mothers from a community sample and 75 mothers after emergency cesarean section. Perceived maternal and infant life threat were assessed at ≤1 week postpartum. Maternal CB-PTSS and probable CB-PTSD were assessed with validated questionnaires up to 6 months postpartum. Covariates were extracted from hospital records. Secondary data analysis with logistic and linear regressions was performed. Results Globally, mothers were significantly more likely to perceive their infant's life to be threatened, rather than their own. Both types of perceived threat were prospectively but differentially associated with maternal CB-PTSS and probable CB-PTSD at 4-6 weeks and 6 months postpartum. Statistical significance was set at p<0.05. Conclusion The type of perceived threat differently influences maternal CB-PTSS and probable CB-PTSD up to 6 months postpartum. These results may be the basis for the development of a short screening instrument after traumatic childbirth in clinical settings. Future studies need to assess the psychometric properties and acceptability of such a brief screening tool.
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Affiliation(s)
- Leah Gilbert
- Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Charles Perkins Center, Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, NSW, Australia
| | - Vania Sandoz
- Child Abuse and Neglect Team, Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Antje Horsch
- Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
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Arora IH, Woscoboinik GG, Mokhtar S, Quagliarini B, Bartal A, Jagodnik KM, Barry RL, Edlow AG, Orr SP, Dekel S. Establishing the validity of a diagnostic questionnaire for childbirth-related posttraumatic stress disorder. Am J Obstet Gynecol 2023:S0002-9378(23)02031-8. [PMID: 37981091 DOI: 10.1016/j.ajog.2023.11.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Labor and delivery can entail complications and severe maternal morbidities that threaten a woman's life or cause her to believe that her life is in danger. Women with these experiences are at risk for developing posttraumatic stress disorder. Postpartum posttraumatic stress disorder, or childbirth-related posttraumatic stress disorder, can become an enduring and debilitating condition. At present, validated tools for a rapid and efficient screen for childbirth-related posttraumatic stress disorder are lacking. OBJECTIVE We examined the diagnostic validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for detecting posttraumatic stress disorder among women who have had a traumatic childbirth. This Checklist assesses the 20 Diagnostic and Statistical Manual of Mental Disorders, posttraumatic stress disorder symptoms and is a commonly used patient-administrated screening instrument. Its diagnostic accuracy for detecting childbirth-related posttraumatic stress disorder is unknown. STUDY DESIGN The sample included 59 patients who reported a traumatic childbirth experience determined in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder criterion A for exposure involving a threat or potential threat to the life of the mother or infant, experienced or perceived, or physical injury. The majority (66%) of the participants were less than 1 year postpartum (for full sample: median, 4.67 months; mean, 1.5 years) and were recruited via the Mass General Brigham's online platform, during the postpartum unit hospitalization or after discharge. Patients were instructed to complete the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, concerning posttraumatic stress disorder symptoms related to childbirth. Other comorbid conditions (ie, depression and anxiety) were also assessed. They also underwent a clinician interview for posttraumatic stress disorder using the gold-standard Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A second administration of the checklist was performed in a subgroup (n=43), altogether allowing an assessment of internal consistency, test-retest reliability, and convergent and diagnostic validity of the Checklist. The diagnostic accuracy of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in reference to the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was determined using the area under the receiver operating characteristic curve; an optimal cutoff score was identified using the Youden's J index. RESULTS One-third of the sample (35.59%) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for a posttraumatic stress disorder diagnosis stemming from childbirth. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, symptom severity score was strongly correlated with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, total score (ρ=0.82; P<.001). The area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.87-0.99), indicating excellent diagnostic performance of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A cutoff value of 28 maximized the sensitivity (0.81) and specificity (0.90) and correctly diagnosed 86% of women. A higher value (32) identified individuals with more severe posttraumatic stress disorder symptoms (specificity, 0.95), but with lower sensitivity (0.62). Checklist scores were also stable over time (intraclass correlation coefficient, 0.73), indicating good test-retest reliability. Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores were moderately correlated with the depression and anxiety symptom scores (Edinburgh Postnatal Depression Scale: ρ=0.58; P<.001 and the Brief Symptom Inventory, anxiety subscale: ρ=0.51; P<.001). CONCLUSION This study demonstrates the validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as a screening tool for posttraumatic stress disorder among women who had a traumatic childbirth experience. The instrument may facilitate screening for childbirth-related posttraumatic stress disorder on a large scale and help identify women who might benefit from further diagnostics and services. Replication of the findings in larger, postpartum samples is needed.
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Affiliation(s)
- Isha Hemant Arora
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Georgia G Woscoboinik
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Salma Mokhtar
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Beatrice Quagliarini
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Alon Bartal
- The School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | - Kathleen M Jagodnik
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston MA
| | - Robert L Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA; Harvard Medical School, Boston, MA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston MA
| | - Scott P Orr
- Department of Psychiatry, Harvard Medical School, Boston MA; Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Sharon Dekel
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston MA.
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