[Validation of the questionnaire for assessing the childbirth experience (QACE) in a French population]

Prevalence, Evolution, and Predictive Factors of Symptoms of Postpartum Posttraumatic Stress Disorder in a French-Speaking Cohort

BACKGROUND

Identifying factors that are predictive for postpartum posttraumatic stress disorder (PTSD) is important to inform clinical and research practice. Yet prospective longitudinal studies investigating symptoms of postpartum PTSD and their prevalence, evolution, comorbidities, and predictors remain limited. The aim of this study was to estimate the prevalence of women's symptoms of PTSD at different times in the postpartum period and to identify comorbidities and predictive factors in a French-speaking sample.

METHODS

A total of 168 women participated in this longitudinal study, which included 3 assessment points: immediate postpartum, 2 months postpartum, and 6 months postpartum. Participants filled out questionnaires regarding sociodemographic characteristics, pregnancy, and birth outcomes; subjective perceptions of birth; and symptoms of depression, anxiety, and PTSD.

RESULTS

Among the participants, 11.7% reported having symptoms of PTSD 2 months after birth and 10.5% reported having symptoms 6 months after birth. Regarding comorbidities and associated factors, depressive symptoms, poor marital adjustment, and impaired maternal-infant bonding were significantly and positively correlated with symptoms of PTSD. Peritraumatic distress, negative perceived childbirth experience, and complications and perceived difficulties during birth were predictive factors for postpartum PTSD.

DISCUSSION

More than 1 in 10 women experienced symptoms of postpartum PTSD. Health care professionals need to be aware of symptoms of postpartum PTSD, predictive factors, and comorbidities to be able to better identify women presenting those symptoms and refer them for appropriate psychological support.

[Posttraumatic stress disorder and emergency cesarean delivery: Incidence and risk factors]

BACKGROUND

Posttraumatic stress disorder (PTSD) is declared in 3 to 6 % of postpartum women (PP) and up to 18.5 % in cases of complications of pregnancy or childbirth. The objective of this study is to assess the prevalence of PTSD after a red code cesarean section and to identify the risk factors among the prenatal vulnerability factors, the birth alert factors and the maintenance factors in PP.

METHOD

A phone or computerized questionnaire including an Questionnaire de stress immédiat and the Posttraumatic Stress Disorder Checklist for DSM-5 was offered to patients who had a red code cesarean section between 05/12/2015 and 02/28/2021 at the University South Hospital of Reunion Island.

RESULTS

Among the 555 cesarean sections selected, 329 parturients responded. The prevalence of PTSD was 20.1 % and was stable over time. The 2 risk factors found were the negative experience of childbirth and the proven traumatic experience. Prenatal vunerability factors were not found to be statistically significant. Almost 3 in 4 women had not been informed of the risk of cesarean section and more than 1 in 2 women did not have an explanation in PP.

CONCLUSION

Red code cesarean sections cause PTSD in 1 in 5 women. This lasting disorder can last up to 6 years after childbirth. This indicates the seriousness of this disorder and the need to prevent it. The risk of developing it is 4 times greater in the event of a traumatic experience proven in the Questionnaire de stress immédiat. Offering this questionnaire in the maternity could be an important element of secondary prevention. The role of health personnel remains essential.

[Determinants of Anxiety Symptoms, Depression and Peri-traumatic Distress in Immediate Postpartum Women's mental health]

OBJECTIVES

The aims of this study were to identify the determinants and the vulnerability factors of women's mental health in the immediate postpartum period by investigating the first symptoms of anxiety, depression and peri-traumatic distress.

METHODS

256 women participated in this cross-sectional and descriptive study. They responded during their stay in the maternity ward to a set of questionnaires between the 1st and the 6th day after delivery. This included an anamnestic questionnaire as well as different scales that evaluated generalized self-efficacy feeling (GSES), marital adjustment (DAS), perceived sense of control during labor and delivery (LAS), birth experience (QEVA), anxiety manifestations (STAI-Y), depressive symptoms (EPDS) and peri-traumatic distress (PDI).

RESULTS

Symptoms of anxiety, depression and peri-traumatic distress in the immediate postpartum period, as indicators of women's mental health, are predicted by different determinants. An anxious personality and perceived complications during childbirth for the woman or baby have been shown to be significant predictors of postpartum anxiety. Symptoms of depression are related to a history of depression, a low overall sense of general efficacy and lower satisfaction in the marital relationship. Peri-traumatic distress is related to certain dimensions of the childbirth experience, such as perceived sense of control, perceived complications and emotions felt during birth.

CONCLUSIONS

Symptoms of depression, anxiety and peritraumatic distress are linked to aspects of the prenatal period, but also to the experience of childbirth. More specific prevention, screening and care measures, depending on the woman's symptomatology, can be implemented during pregnancy or at the maternity. Further research seems essential to better understand the interactions between the prenatal period, childbirth and postpartum in explaining women's mental health in the immediate postpartum period.