Department of Family Practice, University of British Columbia, Vancouver, Canada.
Department of Family Practice, University of British Columbia, Vancouver, Canada.
J Affect Disord. 2025 Jan 15;369:265-275. doi: 10.1016/j.jad.2024.09.144. Epub 2024 Sep 27.
Fear of childbirth (FoB) is experienced to some degree by most pregnant people and can be intense enough to merit treatment. Despite significant research on the topic of FoB, studies investigating various forms of maltreatment and mental health symptoms in relation to FoB are very limited. In particular, studies including multiple forms of maltreatment along with mental health symptoms as predictors of FoB are extremely limited. We sought to fill this gap and clarify the relative contributions of these variables to the prediction of FoB.
This was a secondary analysis of data from pregnant people in Canada. Participants (N = 881) provided demographic and reproductive history information, completed self-report measures of FoB, childhood maltreatment (multiple forms), adult sexual victimization, depressed mood and symptoms of posttraumatic stress disorder (PTSD). They were also administered a diagnostic interview to assess for specific phobia, FoB. Analyses included descriptive information, Wilcoxon rank sum tests, linear and logistic regression, and path analysis.
Most forms of maltreatment showed some association with increased FoB. However, when assessed together, only emotional maltreatment remained a significant predictor of FoB. Both depressed mood and symptoms of PTSD contributed more to FoB than maltreatment, and mediated the relationship of emotional maltreatment with FoB. The only direct effects of childhood emotional maltreatment on FoB were for fears of medical interventions and feelings of embarrassment during labour and delivery.
Study findings fill significant gaps in our understanding of the relationship between maltreatment, mental health symptoms and FoB. However, the study sample was limited to Canadian participants, most of whom were socio-economically advantaged, cis-gender women of European descent, thus limiting the generalizability of the findings. Further, as childhood maltreatment and sexual assault experiences in adulthood were reported retrospectively, study findings are also vulnerable to recall bias.
Findings contribute to our understanding of the relationship between childhood maltreatment, adult sexual victimization, mental health and FoB. These findings can facilitate future research and improved care via a focus on depressed mood, symptoms of PTSD, emotional maltreatment and specific fears of medical interventions and social discomfort as significant contributors to one's experience of FoB.
大多数孕妇都会在某种程度上经历分娩恐惧（FoB），而且这种恐惧强烈到足以需要治疗。尽管对 FoB 进行了大量研究，但关于各种形式的虐待和心理健康症状与 FoB 之间关系的研究非常有限。特别是，将多种形式的虐待以及心理健康症状作为 FoB 预测因素的研究极为有限。我们试图填补这一空白，并阐明这些变量对 FoB 预测的相对贡献。
这是对加拿大孕妇数据的二次分析。参与者（N=881）提供了人口统计学和生殖史信息，完成了 FoB、儿童期虐待（多种形式）、成年性受害、抑郁情绪和创伤后应激障碍（PTSD）症状的自我报告测量。他们还接受了一项诊断访谈，以评估特定恐惧症和 FoB。分析包括描述性信息、Wilcoxon 秩和检验、线性和逻辑回归以及路径分析。
大多数形式的虐待都与 FoB 增加有关。然而，当一起评估时，只有情感虐待仍然是 FoB 的重要预测因素。抑郁情绪和 PTSD 症状对 FoB 的贡献都大于虐待，并且介导了情感虐待与 FoB 之间的关系。儿童期情感虐待对 FoB 的唯一直接影响是对医疗干预的恐惧和分娩时的尴尬感。
研究结果填补了我们对虐待、心理健康症状和 FoB 之间关系的理解中的重大空白。然而，该研究样本仅限于加拿大参与者，其中大多数是社会经济地位较高的、顺性别、欧洲裔女性，因此限制了研究结果的普遍性。此外，由于童年期虐待和成年期性侵害经历是回顾性报告的，因此研究结果也容易受到回忆偏差的影响。
研究结果有助于我们理解儿童期虐待、成年性受害、心理健康和 FoB 之间的关系。这些发现可以通过关注抑郁情绪、PTSD 症状、情感虐待以及对医疗干预和社交不适的特定恐惧，为未来的研究和改善护理提供信息，这些因素是人们经历 FoB 的重要贡献因素。
