Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors

• Published in: Journal of affective disorders Vol. 229; pp. 377 - 385
• Main Authors: Dikmen-Yildiz, Pelin, Ayers, Susan, Phillips, Louise
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.03.2018
• Subjects: Childbirth; Post-traumatic stress disorder; Resilience, Recovery; Risk factors; Trajectories; Trajectories; Childbirth; Risk factors; Post-traumatic stress disorder; Resilience, Recovery
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2017.12.074

Although longitudinal trajectories of post-traumatic stress disorder (PTSD) are well-established in general trauma populations, very little is known about the trajectories of birth-related PTSD. This study aimed to identify trajectories of birth-related PTSD; determine factors associated with each trajectory; and identify women more likely to develop birth-related PTSD. 226 women who had traumatic childbirth according to DSM-IV criterion A were drawn from a community sample of 950 women. Measures were taken of PTSD, affective symptoms, fear of childbirth and social support in pregnancy, 4–6 weeks and 6-months postpartum. Information on some obstetric and psychosocial factors were also prospectively obtained. Four trajectories were identified: resilience (61.9%), recovery (18.5%), chronic-PTSD (13.7%) and delayed-PTSD (5.8%). Resilience was consistently distinguished from other PTSD trajectories by less affective symptoms at 4–6 weeks postpartum. Poor satisfaction with health professionals was associated with chronic-PTSD and delayed-PTSD. When affective symptoms at 4–6 weeks postpartum were removed from the model, less social support and higher fear of childbirth 4–6 weeks after birth predicted chronic and recovery trajectories; whereas experience of further trauma and low levels of satisfaction with health professionals were predictive of chronic-PTSD and delayed-PTSD, compared to resilience. Additional variables associated with different trajectories included antenatal affective symptoms, caesarean-section, preterm birth and receiving professional help. Use of self-report measures, use of DSM-IV criteria for PTSD diagnosis, and no follow-up beyond six months are the main limitations of this study. Identified factors may inform preventive and treatment interventions for women with traumatic birth experiences. •First study to systematically examine longitudinal trajectories of birth-related PTSD.•Trajectories identified were resilient, recovered, chronic, and delayed-PTSD.•Most women (61.9%) had a resilient trajectory characterized by no/mild disruption.•Low affective symptoms distinguished resilient from other PTSD trajectories.•Fear of birth and less support predicted different trajectory patterns.