1
|
Miller ML, Laifer LM, Thomas EBK, Grekin R, O'Hara MW, Brock RL. From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women. J Affect Disord 2024; 357:11-22. [PMID: 38663559 PMCID: PMC11149003 DOI: 10.1016/j.jad.2024.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/18/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood. METHODS Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum. RESULTS Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period. LIMITATIONS Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed. CONCLUSIONS Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.
Collapse
Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Department of Psychiatry, Goodman Hall/IU Health Neuroscience Center, Suite 2800, 355 W. 16th St., Indianapolis, IN 46202, United States of America; University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America.
| | - Lauren M Laifer
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
| | - Emily B K Thomas
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca Grekin
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Michael W O'Hara
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca L Brock
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
| |
Collapse
|
2
|
Handelzalts JE, Kalfon-Hakhmigari M, Raichin A, Peled Y. Postpartum acute stress disorder symptoms, social support, and quality of couple's relationship associations with childbirth PTSD. Front Psychiatry 2024; 15:1310114. [PMID: 38915847 PMCID: PMC11194715 DOI: 10.3389/fpsyt.2024.1310114] [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: 10/09/2023] [Accepted: 05/09/2024] [Indexed: 06/26/2024] Open
Abstract
Background We aimed to examine the hypothesized negative associations between childbirth post-traumatic stress disorder (PTSD) symptoms (using the two-factor model of birth-related and general symptoms), social support, and a couple's relationship quality at 8-12 weeks postpartum. This analysis considered the longitudinal positive shared variance with acute stress disorder (ASD) symptoms measured shortly after birth, while accounting for obstetric and demographic variables. Methods Participants included 246 mothers who gave birth at the maternity ward of a tertiary healthcare center. Self-report questionnaires were used 1-4 days postpartum (T1): Demographic information, the Birth Satisfaction Scale-Revised (BSS-R), and the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS). At T2 (8-12 weeks postpartum), the Multidimensional Scale of Perceived Social Support (MSPSS), the Dyadic Adjustment Scale (DAS-7), and the City Birth Trauma Scale (BiTS). Results In partial support of our hypotheses, three hierarchical regression analyses revealed a significant positive contribution of ASD symptoms to childbirth PTSD general symptoms (β = .33, p <.001) and the total score (β = .29, p <.001), but not to birth-related symptoms. Social support (β = -.21, p = .003) and the quality of the couple's relationship (β=-.20, p = .003) showed negative associations with the BiTS general symptoms. Conclusion Our study enhances understanding of the shared variance between childbirth ASD and PTSD, supporting the factor structure of general and birth-related symptoms as different aspects of childbirth PTSD and highlighting the negative association of social support and the quality of a couple's relationship with PTSD general symptoms, suggesting potential avenues for targeted interventions.
Collapse
Affiliation(s)
- Jonathan E. Handelzalts
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | | | - Adi Raichin
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
3
|
Kaliush PR, Conradt E, Kerig PK, Williams PG, Crowell SE. A multilevel developmental psychopathology model of childbirth and the perinatal transition. Dev Psychopathol 2024; 36:533-544. [PMID: 36700362 PMCID: PMC10368796 DOI: 10.1017/s0954579422001389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.
Collapse
Affiliation(s)
- Parisa R. Kaliush
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Elisabeth Conradt
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27701, USA
| | - Patricia K. Kerig
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Paula G. Williams
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Sheila E. Crowell
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA
| |
Collapse
|
4
|
Nie R, Pan M, Liu X. The mediation role of resilience and postpartum traumatic stress disorder on parental attachment and the maternal-infant bonding. BMC Psychol 2023; 11:359. [PMID: 37891637 PMCID: PMC10612154 DOI: 10.1186/s40359-023-01370-5] [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: 01/16/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS This study aimed to evaluate the correlation between parental attachment, resilience, postpartum traumatic stress disorder (PTSD), and maternal-infant bonding at 1 to 3 months postpartum. The mediation effect of resilience and PTSD on the postpartum parental attachment and maternal-infant bond was also evaluated. DESIGN A cross-sectional research design was used. METHODS A total of 400 postpartum women examined at a tertiary hospital in Wuhan from January 2021 to June 2021 were enrolled in the study. At about 1 to 3 months after giving birth, the women were asked to complete the Postpartum Bonding Questionnaire (PBQ), Connor-Davidson Resilience scale(CD-RISC), PTSD CheckList-Civilian version (PCL-C), and the Parental Bonding Instrument (PBI). The data were summarized using descriptive statistics. Mediation analyse and the Spearman correlation (r) were used to correlate the resilience and PTSD questionnaire scores. RESULTS The care attachment dimension was significantly associated with resilience (r = 0.24, p < 0.01), PTSD (r = - 0.27, p < 0.01), and maternal-infant bonding (r = 0.10, p < 0.01), and the overprotection attachment dimension was significantly associated with resilience (r = - 0.11, p < 0.01), PTSD (r = 0.33, p < 0.01), and maternal-infant bonding (r = 0.16, p < 0.01). Resilience and PTSD can mediate the relationship between attachment and maternal-infant bonding. CONCLUSION Parental attachment, resilience, and PTSD significantly affect maternal-infant bonding at 1 to 3 months postpartum. IMPACT This study demonstrated that new interventions aimed at addressing PTSD symptoms and improving resilience might increase parental attachment and maternal-infant bonding after birth. However, further research is required to evaluate the success of these interventions.
Collapse
Affiliation(s)
- Rong Nie
- College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, China
| | - Mengxia Pan
- Center for Reproductive Medicine, Department of Gynecology, Zhejiang Provincial People's Hospital, (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
- Department of Nursing, Zhejiang Provincial People's Hospital, (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Xinwen Liu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| |
Collapse
|
5
|
Chen J, Lai X, Zhou L, Retnakaran R, Wen SW, Krewski D, Huang L, Li M, Xie RH. Association between exclusive breastfeeding and postpartum post-traumatic stress disorder. Int Breastfeed J 2022; 17:78. [PMID: 36419193 PMCID: PMC9685859 DOI: 10.1186/s13006-022-00519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Research on the association between breastfeeding and postpartum post-traumatic stress disorder (PTSD) is sparse. This study aimed to examine the association between exclusive breastfeeding up to 42 days after childbirth and postpartum PTSD. METHODS An epidemiologic study was conducted in a tertiary hospital in China between October 2019 and October 2020. Eligible mothers were recruited at 3 days after childbirth and assessed using the Post-Traumatic Stress Disorder Checklist - Civilian version (PCL-C) for PTSD at 42 days postpartum. The independent association between exclusive breastfeeding up to 42 days after childbirth and postpartum PTSD was estimated using log-binomial regression models, after adjusting for potential confounders. RESULTS Ninety-two of 759 (12.1%) mothers developed postpartum PTSD within 42 days after childbirth. Compared with partially breastfeeding mothers, exclusively breastfeeding mothers had lower risks of postpartum PTSD (relative risk [RR] 0.28; 95% confidence interval [CI] 0.13, 0.59), re-experience (RR 0.48; 95% CI 0.30, 0.76), avoidance (RR 0.55; 95% CI 0.32, 0.97), and hyperarousal (RR 0.52; 95% CI 0.34, 0.78). After adjustment for family support, parity, mode of delivery, perceived birth trauma, early contact / suckling, and rooming-in, associations between exclusive breastfeeding and postpartum PTSD remained significant: the overall PTSD adjusted relative risk [aRR] was 0.31; (95% CI 0.15, 0.66), with a re-experience aRR of 0.48; (95% CI 0.30, 0.77) and hyperarousal aRR of 0.56; (95% CI 0.37, 0.85). CONCLUSION Exclusive breastfeeding up to 42 days after childbirth was associated with reduced risk of postpartum PTSD. While the potential for reverse causation cannot be ruled out, strategies to improve rates of exclusive breastfeeding through teaching, counselling, and support may benefit mothers and their infants by reducing the risk of postpartum PTSD.
Collapse
Affiliation(s)
- Jingfen Chen
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaolu Lai
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Lepeng Zhou
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Ravi Retnakaran
- grid.416166.20000 0004 0473 9881Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario Canada ,grid.250674.20000 0004 0626 6184Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Division of Endocrinology, University of Toronto, Toronto, Ontario Canada
| | - Shi Wu Wen
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Daniel Krewski
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario Canada ,Risk Science International, Ottawa, Ontario Canada
| | - Liping Huang
- grid.284723.80000 0000 8877 7471Department of Obstetrics and Gynecology, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Meng Li
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.284723.80000 0000 8877 7471Department of Obstetrics, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Ri-hua Xie
- grid.284723.80000 0000 8877 7471Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China ,grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China ,grid.28046.380000 0001 2182 2255The Telfer School of Management, University of Ottawa, Ottawa, Ontario Canada
| |
Collapse
|
6
|
The effects of midwifery care provided to primiparous mothers during the postpartum period on maternal attachment and post-traumatic growth. Midwifery 2021; 103:103140. [PMID: 34571244 DOI: 10.1016/j.midw.2021.103140] [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: 02/04/2021] [Revised: 07/06/2021] [Accepted: 09/05/2021] [Indexed: 11/22/2022]
Abstract
AIM This study was conducted to determine the effects of midwifery care provided to primiparous mothers during the postpartum period on maternal attachment and post-traumatic growth. METHOD The study was conducted based on a quasi-experimental model with a pre-test/post-test control group. The population of the study was composed of primiparous mothers who gave birth in a public hospital located in eastern Turkey, and the sample consisted of 128 postpartum women (64 women in the control group and 64 women in the experimental group); the sample size was determined via power analysis. Midwifery care was provided to the mothers in the experimental group throughout their hospitalisation in accordance with the Postpartum Care Management Guidelines (PCMG) published by the Republic of Turkey's Ministry of Health. In addition, 3 home visits were carried out between the postpartum 2nd and 5th days, 13th and 17th days and 36th and 42nd days. The mothers in the control group were not subjected to any intervention. The data were collected using a personal information form, the Maternal Attachment Inventory (MAI) and the Post-traumatic Growth Inventory (PTGI). Statistical analyses were conducted using percentage distribution, arithmetic mean, standard deviation, chi-square testing, independent samples t-testing and dependent samples t-testing. RESULTS Based on the mean MAI and PTGI pre-test scores, it was determined that the mothers in the experimental and control groups were similar in terms of maternal attachment and post-traumatic growth characteristics (p>0.05). The mean MAI post-test score was 101.85±2.85 in the experimental group and 98.68±5.91 in the control group, and the difference between the groups was statistically significant (p<0.001). The mean PTGI post-test score was 86.21±20.39 in the experimental group and 79.54±22.32 in the control group, and the difference between the groups' mean scores was statistically significant (p<0.05). The mean post-test score of the PTGI Change in Philosophy of Life subscale was 19.37±6.04 in the experimental group and 16.17±6.83 in the control group, and the difference between the mean scores was statistically significant (p<0.05). CONCLUSION It was determined that the midwifery care provided to primiparous mothers during the postpartum period had a positive effect on levels of post-traumatic growth and maternal attachment.
Collapse
|
7
|
Sommerlad S, Schermelleh-Engel K, La Rosa VL, Louwen F, Oddo-Sommerfeld S. Trait anxiety and unplanned delivery mode enhance the risk for childbirth-related post-traumatic stress disorder symptoms in women with and without risk of preterm birth: A multi sample path analysis. PLoS One 2021; 16:e0256681. [PMID: 34464408 PMCID: PMC8407573 DOI: 10.1371/journal.pone.0256681] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022] Open
Abstract
Childbirth-related post-traumatic stress disorder (CB-PTSD) occurs in 3-7% of all pregnancies and about 35% of women after preterm birth (PTB) meet the criteria for acute stress reaction. Known risk factors are trait anxiety and pain intensity, whereas planned delivery mode, medical support, and positive childbirth experience are protective factors. It has not yet been investigated whether the effects of anxiety and delivery mode are mediated by other factors, and whether a PTB-risk alters these relationships. 284 women were investigated antepartum and six weeks postpartum (risk-group with preterm birth (RG-PB) N = 95, risk-group with term birth (RG-TB) N = 99, and control group (CG) N = 90). CB-PTSD symptoms and anxiety were measured using standardized psychological questionnaires. Pain intensity, medical support, and childbirth experience were assessed by single items. Delivery modes were subdivided into planned vs. unplanned delivery modes. Group differences were examined using MANOVA. To examine direct and indirect effects on CB-PTSD symptoms, a multi-sample path analysis was performed. Rates of PTS were highest in the RG-PB = 11.58% (RG-TB = 7.01%, CG = 1.1%). MANOVA revealed higher values of CB-PTSD symptoms and pain intensity in RG-PB compared to RG-TB and CG. Women with planned delivery mode reported a more positive birth experience. Path modeling revealed a good model fit. Explained variance was highest in RG-PB (R2 = 44.7%). Direct enhancing effects of trait anxiety and indirect reducing effects of planned delivery mode on CB-PTSD symptoms were observed in all groups. In both risk groups, CB-PTSD symptoms were indirectly reduced via support by medical staff and positive childbirth experience, while trait anxiety indirectly enhanced CB-PTSD symptoms via pain intensity in the CG. Especially in the RG-PB, a positive birth experience serves as protective factor against CB-PTSD symptoms. Therefore, our data highlights the importance of involving patients in the decision process even under stressful birth conditions and the need for psychological support antepartum, mainly in patients with PTB-risk and anxious traits. Trial registration number: NCT01974531 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Sarah Sommerlad
- Department of Gynecology and Obstetrics, University Hospital of Frankfurt, Frankfurt, Germany
| | | | | | - Frank Louwen
- Department of Gynecology and Obstetrics, University Hospital of Frankfurt, Frankfurt, Germany
| | - Silvia Oddo-Sommerfeld
- Department of Gynecology and Obstetrics, University Hospital of Frankfurt, Frankfurt, Germany
| |
Collapse
|
8
|
Ostacoli L, Cosma S, Bevilacqua F, Berchialla P, Bovetti M, Carosso AR, Malandrone F, Carletto S, Benedetto C. Psychosocial factors associated with postpartum psychological distress during the Covid-19 pandemic: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:703. [PMID: 33208115 PMCID: PMC7671935 DOI: 10.1186/s12884-020-03399-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/05/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Trauma, natural and man-made catastrophic events can be predictors of postpartum psychological distress. In a public health response due to coronavirus disease 2019 outbreak, the Italian government imposed a lockdown from March 9 to May 3. This extraordinary situation may have been challenging for maternal psychological health. The aim of this study was to investigate the prevalence of depressive and post-traumatic stress symptoms in women giving birth during the Covid-19 pandemic and its associations with quarantine measures, obstetrical factors, and relational attachment style. METHODS Women who gave birth in a high-volume obstetric/gynaecological medical centre located in an epidemic area during the Covid-19 pandemic (March 8 to June 15) were asked to complete an online survey about their childbirth experience and the perceived effect of the pandemic. The Edinburgh Postnatal Depression Scale (EPDS), the Impact of Event Scale-Revised (IES-R), and the Relationship Questionnaire (RQ) were administered to assess levels of postpartum depressive and post-traumatic stress symptoms (PTSS) and relational style of attachment, respectively. Multivariate analysis was applied to identify associations between quarantine measures, childbirth experience, attachment style, and EPDS and IES-R scores. RESULTS The survey was completed by 163 women (response rate 60.8%). The prevalence of depressive symptoms was 44.2% (EPDS cut-off score ≥ 11) and the PTSS rate was 42.9% (IES-R cut-off score ≥ 24). Dismissive and fearful avoidant attachment styles were significantly associated with the risk of depression and PTSS, respectively. Perceived pain during birth was a risk factor for postpartum depression. Perceived support provided by healthcare staff was a protective factor against depression and PTSS. Another protective factor against PTSS was quiet on the ward due to the absence of hospital visitors. CONCLUSION This study reports a high prevalence of postpartum depressive and PTSS in women who gave birth during the Covid-19 pandemic. Postnatal psychological distress seemed to be associated more with the prenatal experience and other individual factors than with the pandemic hospital restrictions. Early detection during pregnancy of an insecure attachment style is fundamental to provide targeted preventive and therapeutic psychological interventions.
Collapse
Affiliation(s)
- Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- Clinical Psychology Service, City of Health and Science, Torino, Italy
| | - Stefano Cosma
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Federica Bevilacqua
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Marialuisa Bovetti
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Andrea Roberto Carosso
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| | - Francesca Malandrone
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Sara Carletto
- Clinical Psychology Service, City of Health and Science, Torino, Italy.
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy.
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy
| |
Collapse
|
9
|
MacMillan KK, Lewis AJ, Watson SJ, Jansen B, Galbally M. Maternal trauma and emotional availability in early mother-infant interaction: findings from the Mercy Pregnancy and Emotional Well-being Study (MPEWS) cohort. Attach Hum Dev 2020; 23:853-875. [PMID: 32684110 DOI: 10.1080/14616734.2020.1790116] [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: 10/23/2022]
Abstract
Understanding how a mother's traumatic experiences influence her interactions with her infant may have importance for understanding infant development and mental health. Data for this study were drawn from an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Maternal trauma from Childhood, Childbirth Experiences, and Stressful Life Events were examined. At six-months postpartum, 211 predominantly first-time mothers (mean age 31.5 years), and their infants, were video-recorded interacting for 40 minutes. Interactions were assessed with the Emotional Availability (EA) Scales. Using structural equation modelling to test multiple mediation pathways, moderate-to-severe childhood trauma had only a direct effect on reducing maternal EA with the infant (β=-.17, p=.031), as did current stressful life events (β=-.19, p=.019), after controlling for maternal depression, age, and tertiary education. This highlights that proximate trauma specific to the perinatal period may not account for the effect of distal childhood trauma on maternal EA at six-months postpartum.
Collapse
Affiliation(s)
- Kelli K MacMillan
- The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Andrew J Lewis
- The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Stuart J Watson
- The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia.,School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Brendan Jansen
- Women's Health, Genetics and Mental Health Directorate, King Edward Memorial Hospital for Women, Perth, Australia
| | - Megan Galbally
- The College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia.,School of Medicine, University of Notre Dame, Fremantle, Australia.,Women's Health, Genetics and Mental Health Directorate, King Edward Memorial Hospital for Women, Perth, Australia.,Faculty of Health and Medicine Sciences, University of Western Australia, Perth, Australia
| |
Collapse
|
10
|
Townsend ML, Brassel AK, aafi M, Grenyer BFS. Childbirth satisfaction and perceptions of control: postnatal psychological implications. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjom.2020.28.4.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BackgroundSatisfaction with childbirth is associated with a number of factors prior to and during birth, including perceived control during labour, and has implications for postnatal psychological health.MethodsA total of 38 pregnant women recruited prior to 20-weeks gestation completed questionnaires regarding perceptions of control during, and satisfaction with, childbirth, mental health and maternal attachment at two-months postpartum. Birth details and breastfeeding difficulties were obtained from hospital records.ResultsSatisfaction with childbirth was associated with perceived control and a physiological birth, and perceived control was associated with a physiological birth and midwife-led continuity of care. At two-months postpartum, satisfaction with childbirth was associated with fewer depressive symptoms, while perceived control was associated with fewer anxiety symptoms.DiscussionIt is important for healthcare providers to implement practices that support birthing satisfaction, such as provision of midwife-led continuity of care. Healthcare provision should also provide psychological support to mothers whose birthing experience was unsatisfactory and tailor additional support during early breastfeeding for these women.
Collapse
Affiliation(s)
- Michelle L Townsend
- Illawarra Health and Medical Research Institute and school of psychology, University of Wollongong, Australia
| | - Alexandra K Brassel
- Illawarra Health and Medical Research Institute and school of psychology, University of Wollongong, Australia
| | - Mercy aafi
- School of nursing, University of Wollongong
| | - Brin FS Grenyer
- Illawarra Health and Medical Research Institute and school of psychology, University of Wollongong, Australia
| |
Collapse
|