Seng Julia S, Low Lisa Kane, Sperlich Mickey, Ronis David L, Liberzon Israel
From the University of Michigan Institute for Research on Women and Gender, School of Nursing, Department of Women's Studies, Department of Obstetrics and Gynecology; University of Michigan School of Nursing, Department of Women's Studies, Department of Obstetrics and Gynecology; University of Michigan Institute for Research on Women and Gender; University of Michigan School of Nursing and Ann Arbor Veterans' Affairs Health System; and University of Michigan Department of Psychiatry, Ann Arbor, Michigan.
Obstet Gynecol. 2009 Oct;114(4):839-847. doi: 10.1097/AOG.0b013e3181b8f8a2.
To estimate prevalence and assess the association of types of trauma with posttraumatic stress disorder (PTSD) in a sociodemographically and racially mixed sample of women from both predominantly Medicaid and privately insured settings who are expecting their first infant.
Structured telephone diagnostic interview data were analyzed for prevalence of trauma exposure, PTSD, comorbidity, risk behaviors, and treatment-seeking among 1,581 diverse English-speaking nulliparous women.
The overall rate of lifetime PTSD was 20.2%, 17% in the predominantly private-payer settings, and 24% in the predominantly public-payer settings. The overall rate of current PTSD was 7.9%, 2.7% in the predominantly private-payer settings and 13.9% in the predominantly public-payer settings. Those with current PTSD were more likely to be African American, pregnant as a teen, living in poverty, with high school education or less, and living in higher-crime areas. Adjusted odds of having current PTSD were highest among those whose worst trauma exposure was abuse (odds ratio 11.9, 95% confidence interval 3.6-39.9), followed by reproductive trauma (odds ratio 6.1, 95% confidence interval 1.5-24.4). Health risk behaviors and exposures were concentrated among those with PTSD.
These findings affirm that PTSD affects pregnant women. Women with PTSD in pregnancy were more likely to have had exposures to childhood abuse and prior traumatic reproductive event, to have cumulative sociodemographic risk factors, comorbid depression and anxiety, and to have sought mental health treatment in the past. Obstetric risk behaviors occur more in women with PTSD.
II.
在一个社会人口统计学和种族构成多样的样本中，该样本包含来自主要参加医疗补助计划和私人保险计划的首次怀孕女性，估计创伤发生率，并评估创伤类型与创伤后应激障碍（PTSD）之间的关联。
对1581名讲英语的不同初产妇进行结构化电话诊断访谈，分析创伤暴露、创伤后应激障碍、共病、风险行为和寻求治疗的发生率。
终生创伤后应激障碍的总体发生率为20.2%，主要为私人付费患者的发生率为17%，主要为公共付费患者的发生率为24%。当前创伤后应激障碍的总体发生率为7.9%，主要为私人付费患者的发生率为2.7%，主要为公共付费患者的发生率为13.9%。患有当前创伤后应激障碍的女性更可能是非裔美国人、青少年怀孕、生活贫困、接受过高中及以下教育，且生活在犯罪率较高的地区。在创伤暴露最严重为虐待的人群中，发生当前创伤后应激障碍的校正比值最高（比值比11.9，95%置信区间3.6 - 39.9），其次是生殖创伤（比值比6.1，95%置信区间1.5 - 24.4）。健康风险行为和暴露集中在患有创伤后应激障碍的人群中。
这些发现证实创伤后应激障碍会影响孕妇。孕期患有创伤后应激障碍的女性更有可能曾遭受童年虐待和既往创伤性生殖事件，具有累积的社会人口统计学风险因素、共病的抑郁和焦虑，且过去曾寻求心理健康治疗。产科风险行为在患有创伤后应激障碍的女性中更为常见。
II级。
