Catalao Raquel, Kebede Lelina, Mulushoa Adiyam, Eshetu Tigist, Medhin Girmay, Abdella Ahmed, Alem Atalay, Keynejad Roxanne C, Sandall Jane, Howard Louise M, Prince Martin, Hanlon Charlotte
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King´s College London, United Kingdom.
St Barnabas Hospital, Bronx, New York, United States of America.
PLoS One. 2025 Sep 5;20(9):e0319362. doi: 10.1371/journal.pone.0319362. eCollection 2025.
We aimed to describe the prevalence of exposure to traumatic events and post-traumatic stress disorder (PTSD) in pregnant women attending antenatal care (ANC) in rural Ethiopia. We hypothesised that antenatal PTSD symptoms would be associated with previous obstetric complications and intimate partner violence (IPV) and impact negatively on women´s satisfaction with ANC.
The design was a facility-based cross-sectional study in primary health centres providing ANC in southern Ethiopia. Trauma events were assessed using the Life Events Checklist (LEC) and PTSD checklist for DSM-5 (PCL-5). Previous obstetric complications were extracted from clinical records. IPV was measured using the 'Non-Graphic Language' screening test and ANC satisfaction was measured using a locally validated adapted version of the Mental Health Service Satisfaction Scale. Generalized linear mixed-effects regression models were used to calculate prevalence ratios between PTSD, IPV and ANC satisfaction.
Out of 2079 interviewed women, 52.3% (n = 1,087) reported one or more traumatic life events on the LEC. Physical assault was the most common traumatic event experienced (n = 485; 23.3%) and witnessed (n = 1,176; 56.6%) but only 289 (13.9%) screened positive for IPV. One hundred and six women (5.1%) met DSM-5 criteria for PTSD. Women meeting diagnostic criteria for PTSD had five times increased prevalence of IPV in their current pregnancy [prevalence ratio (PR) 4.34, 95%CI 3.01-6.30; p < 0.001]. Only twenty-six women had a record of previous obstetric complications (0.01%). Overall, women with PTSD reported less satisfaction with antenatal care.
Despite high exposure to traumatic life events, particularly physical violence, among pregnant women attending ANC in Southern Ethiopia, the prevalence of PTSD is relatively low. Previous obstetric complications and IPV were under-reported, relative to known prevalence estimates. Our study highlights the challenges of detection of psychosocial needs in the ANC setting and the need for targeted interventions to support women's disclosure of difficulties in maternity care settings.
我们旨在描述埃塞俄比亚农村地区接受产前护理（ANC）的孕妇中创伤性事件暴露率及创伤后应激障碍（PTSD）情况。我们假设产前PTSD症状与既往产科并发症及亲密伴侣暴力（IPV）相关，并对妇女对ANC的满意度产生负面影响。
本研究为在埃塞俄比亚南部提供ANC的初级卫生中心开展的基于机构的横断面研究。使用生活事件清单（LEC）和DSM-5创伤后应激障碍检查表（PCL-5）评估创伤事件。从临床记录中提取既往产科并发症情况。使用“非图形语言”筛查测试测量IPV，使用经本地验证的心理健康服务满意度量表改编版测量对ANC的满意度。采用广义线性混合效应回归模型计算PTSD、IPV与ANC满意度之间的患病率比。
在2079名接受访谈的妇女中，52.3%（n = 1087）报告在LEC上有一项或多项创伤性生活事件。身体攻击是经历（n = 485；23.3%）和目睹（n = 1176；56.6%）最常见的创伤性事件，但只有289人（13.9%）IPV筛查呈阳性。106名妇女（5.1%）符合DSM-5 PTSD诊断标准。符合PTSD诊断标准的妇女在本次妊娠中IPV患病率增加了四倍[患病率比（PR）4.34，95%CI 3.01 - 6.30；p < 0.001]。只有26名妇女有既往产科并发症记录（0.01%）。总体而言，患有PTSD的妇女对产前护理的满意度较低。
尽管在埃塞俄比亚南部接受ANC的孕妇中，遭受创伤性生活事件，尤其是身体暴力的比例较高，但PTSD患病率相对较低。相对于已知的患病率估计，既往产科并发症和IPV报告不足。我们的研究凸显了在ANC环境中检测心理社会需求的挑战，以及需要有针对性的干预措施来支持妇女在产科护理环境中披露困难。
