A questionnaire that detects strong emotional responses to a traumatic birth experience could identify new mothers most at risk for later developing childbirth-related post-traumatic stress disorder (PTSD), according to a study funded by the National Institutes of Health. A high score on the questionnaire correctly identified 88% of the new mothers who later scored high on a questionnaire identifying those with childbirth-related PTSD. The findings could lead to faster identification of PTSD among new mothers, an under-diagnosed condition that increases the risk for depression and anxiety and interferes with mother and child bonding.
The study was conducted by Kathleen M. Jagodnik, Ph.D., research fellow, and senior author Sharon Dekel, Ph.D., of Massachusetts General Hospital and Harvard Medical School, and colleagues. It appears in the Journal of Affective Disorders. NIH funding was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Background
According to previous studies, about 20 to 30% of the roughly 4 million Americans who give birth each year have a highly stressful childbirth experience, some with potentially life-threatening events. Childbirth-related PTSD is estimated to occur in 3 to 6% of those who have complicated deliveries, affecting an estimated 120,000 to 240,000 women each year.
Symptoms of PTSD include recurrent memories or dreams about a traumatic event, reliving the event, distressing thoughts, and ongoing negative emotions such as fear, anger, and guilt. Childbirth-related PTSD may interfere with maternal-infant attachments and lead to behavior problems in children. Because childbirth-related PTSD often goes undiagnosed, it often goes untreated.
A strong emotional and psychological response to a traumatic event precedes PTSD. For the current study, the authors sought to identify the response to the traumatic event that leads to PTSD to find a way to identify patients at high risk.
More than 3,000 patients responded to the peritraumatic stress inventory (PDI)—a questionnaire gauging strong emotional responses to stressful events—within 2.5 months, on average, after giving birth. Patients were asked how strongly they agreed with statements measuring negative emotions, such as “I felt sadness and grief” and “I felt helpless.” Other statements categorized the physical response to trauma like “I felt I might pass out” and “I had physical reactions like sweating, shaking, and my heart pounding.”
The patients later responded to the Posttraumatic Stress Disorder Checklist (PCL-5), a questionnaire designed to detect people at risk for childbirth-related posttraumatic stress disorder. In a previous study, the researchers found that a high score on the PCL-5 corresponded with a mental health specialist’s diagnosis of PTSD.
Results
The researchers found that 88% of participants scoring 15 or higher also had a high enough score on the PCL-5 to indicate a greater risk of childbirth-related PTSD. Similarly, 93% of those who scored below 15 also scored below the threshold for PTSD on the PCL-5.
Significance
The authors concluded that the PDI could be effective at identifying patients at risk for childbirth-related PTSD soon after childbirth so they can be directed to appropriate mental health services early.
Next Steps
The authors hope to administer PDI to a group of patients who have not yet left the hospital after delivery to determine how early it can be used as a screening method for childbirth-related PTSD.
Reference
Jagodnik, KM, et al. Screening for post-traumatic stress disorder following childbirth using the Peritraumatic Distress Inventory. Journal of Affective Disorders. 2023.
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