Department of Psychological Sciences, Institute of Health and Life Sciences, University of Liverpool, Liverpool, UK.
School of Community Health and Midwifery, University of Central Lancashire, Preston, UK.
BJOG. 2020 Jun;127(7):886-896. doi: 10.1111/1471-0528.16163. Epub 2020 Feb 27.
To test whether providing psychological self-help materials would significantly lower the incidence of post-traumatic stress disorder (PTSD) at 6-12 weeks postnatally.
Open-label randomised controlled trial, with blinded outcome assessment.
Community midwifery services in two National Health Service (NHS) trusts in the North West.
A cohort of 2419 women receiving normal NHS postnatal care.
Midwives screened women for traumatic birth experience; 678 women who screened positively (28.1%) were randomly allocated to self-help with usual care (n = 336) or to usual care alone (n = 342). The self-help materials were a leaflet and online film designed to prevent the development of PTSD after trauma exposure through explaining how to manage early psychological responses.
The primary outcome was a composite of diagnostic and subdiagnostic PTSD at 6-12 weeks postnatally using the gold-standard Clinician-Administered PTSD Scale (CAPS-5) interview.
Of the 678 women correctly randomised plus the nine women randomised in error, 478 (70.5%) were followed up. Diagnostic or subdiagnostic PTSD rates at follow-up did not differ between groups who received self-help (26.7%, 65/243) or usual care alone (26.2%, 64/244) (intention-to-treat analysis: RR 1.02, 95% CI 0.68-1.53). Findings remained consistent in the per-protocol analysis (RR 1.04, 95% CI 0.85-1.27). Women viewed the materials very positively. There were no adverse effects. Health economic micro-costing indicated implementation would be very low cost.
Many women experience a traumatic birth and risk developing PTSD, but self-help strategies without professional support are insufficient and should not be routinely introduced.
Self-help information alone does not reduce the number of women developing PTSD after a traumatic childbirth.
测试在产后 6-12 周时提供心理自助材料是否会显著降低创伤后应激障碍（PTSD）的发生率。
开放标签随机对照试验，结果评估设盲。
西北两个国民保健制度（NHS）信托社区助产服务。
接受常规 NHS 产后护理的 2419 名妇女队列。
助产士对创伤性分娩经历的妇女进行筛查；678 名筛查阳性（28.1%）的妇女被随机分配至自助与常规护理（n=336）或常规护理（n=342）。自助材料是一份传单和在线影片，旨在通过解释如何管理创伤后早期心理反应来预防 PTSD 的发生。
主要结局是产后 6-12 周使用金标准临床医生管理 PTSD 量表（CAPS-5）访谈的诊断和亚诊断 PTSD 的综合结果。
在正确随机分配的 678 名妇女加上错误随机分配的 9 名妇女中，有 478 名（70.5%）得到了随访。接受自助治疗（26.7%，243 名中有 65 名）或单独接受常规护理（26.2%，244 名中有 64 名）的两组在随访时的诊断或亚诊断 PTSD 发生率没有差异（意向治疗分析：RR 1.02，95%CI 0.68-1.53）。在方案分析中，结果仍然一致（RR 1.04，95%CI 0.85-1.27）。妇女对这些材料的评价非常积极。没有不良影响。健康经济微观成本分析表明实施成本非常低。
许多妇女经历了创伤性分娩并面临 PTSD 的风险，但没有专业支持的自助策略是不够的，不应常规引入。
单独的自助信息并不能减少创伤性分娩后 PTSD 发生的女性数量。
