Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
J Affect Disord. 2018 Mar 15;229:377-385. doi: 10.1016/j.jad.2017.12.074. Epub 2018 Jan 2.
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.
虽然创伤后应激障碍（PTSD）的纵向轨迹在一般创伤人群中已经得到很好的确定，但对于与分娩相关的 PTSD 的轨迹知之甚少。本研究旨在确定与分娩相关的 PTSD 轨迹；确定与每个轨迹相关的因素；并确定更有可能发展为与分娩相关的 PTSD 的女性。
从 950 名女性的社区样本中抽取了 226 名符合 DSM-IV 标准 A 的创伤性分娩的女性。在产后 4-6 周和 6 个月时测量 PTSD、情感症状、对分娩的恐惧和社会支持。还前瞻性地获得了一些产科和心理社会因素的信息。
确定了 4 种轨迹：韧性（61.9%）、恢复（18.5%）、慢性 PTSD（13.7%）和延迟 PTSD（5.8%）。在产后 4-6 周时，较少的情感症状将韧性与其他 PTSD 轨迹区分开来。对卫生专业人员的满意度差与慢性 PTSD 和延迟 PTSD 相关。当从模型中去除产后 4-6 周的情感症状时，产后 4-6 周的社会支持较少和对分娩的恐惧程度较高预测了慢性和恢复轨迹；而进一步的创伤经历和对卫生专业人员的满意度较低与慢性 PTSD 和延迟 PTSD 相关，而不是韧性。与不同轨迹相关的其他变量包括产前情感症状、剖宫产、早产和接受专业帮助。
本研究的主要局限性是使用自我报告的措施、使用 DSM-IV PTSD 诊断标准以及没有超过六个月的随访。
确定的因素可能为有创伤分娩经历的女性提供预防和治疗干预措施。
