Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
Laboratory of Psychology, Cognition, Behavior and Communication, Univ Rennes, Rennes, France.
J Affect Disord. 2021 Dec 1;295:305-315. doi: 10.1016/j.jad.2021.08.024. Epub 2021 Aug 24.
Certain populations are at high risk of experiencing a traumatic event and developing post-traumatic stress disorder (PTSD). Yet, primary preventive interventions against PTSD are lacking. It is therefore crucial to identify pre-traumatic risk factors, which could be targeted with such interventions. Insomnia may be a good candidate, but studies on civilians are sparse. Furthermore, the mechanisms at stake in the relationship between pre-traumatic insomnia and PTSD symptoms are unclear.
This prospective population-based cohort study (n = 1,610) examined the relationship between insomnia symptoms at 32 weeks of pregnancy and childbirth-related PTSD (CB-PTSD) symptoms at eight weeks postpartum. Postnatal insomnia symptoms, prenatal psychological symptoms (depression, anxiety, PTSD, fear of childbirth), subjective birth experience (SBE) and birth medical severity were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach.
The relationship between prenatal insomnia and CB-PTSD symptoms was mediated by negative SBE and postnatal insomnia symptoms. All relationships involving insomnia symptoms had small or very small effect sizes.
This study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured.
Prenatal insomnia symptoms may impair the ability to cope with a difficult birth experience and contribute to postnatal insomnia, a risk factor for CB-PTSD. Thus, prenatal insomnia symptoms may be a promising target for CB-PTSD primary preventive interventions, although other prenatal psychological symptoms could also be considered. Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate.
某些人群面临着经历创伤事件和发展创伤后应激障碍（PTSD）的高风险。然而，针对 PTSD 的初级预防干预措施却缺乏。因此，确定创伤前的风险因素至关重要，这些因素可以作为此类干预措施的目标。失眠可能是一个很好的候选因素，但针对平民的研究却很少。此外，创伤前失眠与 PTSD 症状之间关系中涉及的机制尚不清楚。
本前瞻性基于人群的队列研究（n=1610）考察了妊娠 32 周时的失眠症状与产后 8 周时与分娩相关的 PTSD（CB-PTSD）症状之间的关系。产后失眠症状、产前心理症状（抑郁、焦虑、PTSD、对分娩的恐惧）、主观分娩经历（SBE）和分娩医疗严重程度被纳入分析中的协变量，分析基于分段结构方程建模方法。
产前失眠与 CB-PTSD 症状之间的关系受到负面 SBE 和产后失眠症状的中介。涉及失眠症状的所有关系都具有较小或非常小的效应大小。
本研究使用了自我报告问卷。产后失眠和 CB-PTSD 症状是同时测量的。
产前失眠症状可能会削弱应对困难分娩经历的能力，并导致产后失眠，这是 CB-PTSD 的一个风险因素。因此，产前失眠症状可能是 CB-PTSD 初级预防干预的一个有前途的目标，尽管其他产前心理症状也可以考虑。即使在围产期之外，未来关于创伤前失眠和 PTSD 的研究也应将创伤后失眠作为协变量纳入其中。
