Posttraumatic stress disorder and coping strategies in the postpartum period: A symptomics approach

Exploring the role of different coping styles in mediating the relationship between dyadic adjustment status and postpartum depression among postnatal women: a single-centre, cross-sectional study

OBJECTIVES

Postpartum depression (PPD) is a prevalent complication of childbearing, with numerous risk factors associated with its onset. Although the risk factors for PPD among postpartum women have been studied, the mechanisms underlying these factors remain inadequately understood. This study aimed to investigate the direct and mediating roles of different coping styles in the relationship between dyadic adjustment status and PPD among women 6 weeks postdelivery.

DESIGN

Single-centre, cross-sectional study.

SETTING

A tertiary care setting in Chengdu City, Sichuan Province, China, from July 2022 to January 2023.

PARTICIPANTS

The study involved 626 women 6 weeks post-delivery.

OUTCOME MEASURES

The Dyadic Adjustment Scale, the Simplified Coping Style Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS) were used to evaluate the dyadic adjustment status, coping styles and the depressive condition of postpartum women, respectively. Data analysis encompassed correlation and mediation analyses based on structural equation modelling.

RESULTS

EPDS scores were significantly correlated with all four dimensions of dyadic adjustments status as well as with both positive and negative coping styles. Dyadic consensus (β = -0.16, p=0.005), affectional expression (β = -0.14, p=0.008) and dyadic cohesion (β = -0.10, p=0.037) directly correlated with PPD after adjusting for covariates. For dyadic satisfaction, the mediating effects of positive and negative coping styles on PPD were -0.04 (95% CI: -0.08 to -0.01) and -0.07 (95% CI: -0.11 to -0.03), respectively. Moreover, both positive and negative coping styles were identified as mediators in the relationship between dyadic cohesion and PPD, with mediating effects of -0.01 (95% CI: -0.03 to -0.00) and -0.09 (95% CI: -0.14 to -0.04), respectively. No mediation was found in the association between affectional expression and PPD.

CONCLUSION

Our findings suggest that both positive and negative coping styles mediate the relationship between dyadic adjustment status and PPD, especially concerning dyadic satisfaction and dyadic cohesion.

Prenatal couple relationship satisfaction, romantic attachment, and childbirth-related posttraumatic stress symptoms

BACKGROUND

Traumatic childbirth can lead to childbirth-related posttraumatic stress symptoms (CB-PTSS). Although underexplored, prenatal couple relationship satisfaction and romantic attachment orientations are modifiable factors that may increase or mitigate the risk of CB-PTSS after a traumatic childbirth experience.

OBJECTIVES

This study examined (1) the associations between prenatal couple relationship satisfaction and romantic attachment, traumatic childbirth and CB-PTSS; (2) whether prenatal couple relationship satisfaction moderates the association between traumatic childbirth and CB-PTSS; and (3) whether the interaction between prenatal couple relationship satisfaction and romantic attachment moderates the association between traumatic childbirth and CB-PTSS.

METHOD

The sample included 162 mothers from a Portuguese longitudinal cohort who completed self-report questionnaires at the third trimester of pregnancy (T1) and at two months postpartum (T2), on sociodemographic, mental health-related, and obstetric data (T1 and T2), couple relationship satisfaction (T1), romantic attachment (T1), traumatic childbirth experience (T2) and CB-PTSS (T2). Hierarchical regression analyses and moderated moderation models were performed.

RESULTS

Lower prenatal couple relationship satisfaction predicted greater CB-PTSS severity, before accounting for attachment-related anxiety and avoidance. Attachment-related anxiety predicted greater CB-PTSS severity. The association between traumatic childbirth experience and CB-PTSS severity was only significant at low levels of prenatal couple relationship satisfaction and medium or high levels of attachment-related anxiety.

CONCLUSIONS

Especially in mothers reporting higher attachment-related anxiety, lower prenatal couple relationship satisfaction seems to increase the risk of CB-PTSS following the experience of a traumatic childbirth. Couple relationship satisfaction and romantic attachment orientations should be assessed during routine prenatal screenings, along with childbirth experiences.

Predictors of Traumatization Among Humanitarian Aid Workers Working With Refugees and Asylum Seekers in Türkiye

Refugees and asylum-seekers flee their countries due to conflict, violence or persecution and seek safety in another country. Professionals working with refugees in host countries are being exposed to the narratives of their traumatic experiences, an important risk factor for vicarious posttraumatic stress. The current study examined predictors for traumatic stress in humanitarian aid workers working with refugees and asylum seekers in Türkiye. We surveyed 156 participants (67.3% women) from various disciplines (psychologists, social workers, interpreters, lawyers etc.) to examine their traumatic stress, resilience and stress coping mechanisms. We used Secondary Traumatic Stress Scale (STSS), Adult Resilience Measure (ARM) and Coping Styles Inventory (CSI) for data collection. In this cross-sectional study, data were collected online from participants who were contacted through snowball sampling method, starting with the participants working with refugees at public agencies and NGOs. The regression analyses showed that the level of traumatic stress is predicted by feelings of fatigue, number of years worked with the refugees, presence of previous psychological problems and being a social worker. The "relational resources" subdimension of resilience and "helpless coping style" are also significantly associated with traumatic stress. Considering the rapidly developing phenomenon of migration all over the world, the findings of the current study could contribute to improve protective and preventive interventions for the psychological wellbeing of humanitarian aid workers.

Post-traumatic stress disorder following childbirth: a neglected cause

Post-traumatic stress disorder (PTSD) following childbirth is a significant mental health risk for women globally. However, it remains a neglected cause, particularly in low-income countries like Pakistan. This paper explores the unique challenges faced by women in such settings, including limited access to healthcare and social support, cultural norms, and stigma surrounding mental health. The diagnosis and causes of postpartum PTSD are discussed, along with its effects on both mothers and their infants. The lack of awareness and training among healthcare professionals in recognizing and treating postpartum PTSD is highlighted as a major barrier to adequate care. To address these challenges, the paper proposes a comprehensive approach, including raising public awareness, providing mental health support and resources, and integrating postpartum mental health into medical education. Trauma-focused therapies are recommended for effective treatment. The paper concludes with the need for more research in low-income countries and emphasizes the importance of understanding and supporting women with postpartum PTSD to improve their well-being and maternal and child health.

Correlates of avoidance coping in trauma-exposed U.S. military veterans: Results from the National Health and Resilience in Veterans Study

Avoidant coping strategies, which involve cognitions and behaviors aimed to avoid dealing with stressful experiences, are associated with adverse long-term mental and physical health outcomes. In response to traumatic events, these strategies can be maladaptive as they may interfere with the adaptive integration of traumatic events into consolidated memories. Using data from a nationally representative sample of more than 3000 trauma-exposed U.S. military veterans (mean time since trauma 30.9 years, SD = 19.9), we employed a network analytic approach to examine pairwise associations between key sociodemographic, personality, and psychosocial risk factors in relation to the endorsement of avoidant coping strategies. Results revealed that negative affect symptoms of posttraumatic stress disorder (PTSD) and adverse childhood experiences were positively associated with engagement in avoidance coping, and that greater emotional stability and conscientiousness were negatively associated with this measure. Secondary network analysis of individual negative affect symptoms of PTSD suggested that blaming oneself and/or others for the traumatic event, emotional neglect, and sexual abuse were most strongly linked to avoidance coping. Collectively, these results suggest that strong feelings of blame related to trauma, emotional neglect, and sexual abuse are associated with greater likelihood of engaging in avoidance coping, while emotional stability and conscientiousness are associated with a lower likelihood of engaging in such strategies.