A questionnaire can detect posttraumatic stress disorder (PTSD) after childbirth with high probability, suggests an early study funded by the National Institutes of Health. A high score on the questionnaire correlated with a mental health specialist’s diagnosis in roughly 87% of cases. A low score correlated with a negative diagnosis in about 90% of cases. According to the researchers, the questionnaire could provide a rapid and efficient method for screening PTSD in people who have recently given birth so that they could be referred for a thorough assessment and offered treatment.
The study was conducted by Sharon Dekel, Ph.D., of Harvard Medical School, and colleagues. It appears in the American Journal of Obstetrics and Gynecology. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Background
According to previous studies, about a third of people who have given birth say the experience involved an intervention that could be perceived as traumatic, such as cesarean delivery or postpartum hemorrhage. Roughly 2 percent experienced a potentially serious event, like a heart attack, heart failure, blood infection, or hysterectomy. Such complicated deliveries may be accompanied by fear and negative thoughts that lead to PTSD, a mental health disorder triggered by witnessing or experiencing a traumatic event. Estimates of PTSD incidence after a complicated delivery range from roughly 18% to 41%.
Childbirth-related PTSD may interfere with breastfeeding, bonding with the infant, and with the desire for a future pregnancy. It also may worsen maternal depression and lead to suicidal behavior.
Childbirth-related PTSD is diagnosed with a structured interview by a trained clinician, which is too lengthy and expensive for rapid screening of individuals who may be suffering from the condition. The Posttraumatic Stress Disorder Checklist (PCL-5) is used to screen for PTSD among veterans, survivors of sexual assault, natural disasters, and automobile accidents.
For the current study, researchers compared a version of the PCL-5 checklist adapted to childbirth to the structured interview by a clinician. A total of 59 participants who had a traumatic childbirth experience completed the PCL-5 checklist and underwent the structured PTSD interview by a clinician.
Results
Of those who were identified as having PTSD by scoring at least 28 out of a high score of 80 points, 81% were also identified as having PTSD by the clinician interview. Of those not identified as having PTSD because they scored less than 28, 90% were classified as not having the disorder by the clinician interview. Overall, 86% of screened people can be classified correctly as having PTSD or not, based on a test score of 28 or higher or below 28. A score of 32 or higher captures 87% of those with the disorder.
Significance
“If you give a person who had a traumatic childbirth the PCL-5—which takes a maximum of 15 minutes to complete—their score could tell us with high probability whether they are likely to suffer from PTSD related to childbirth,” Dr. Dekel said.
The test may make it easier to screen a large number of patients for childbirth-related PTSD and identify those who might benefit from testing and mental health services.
Next Steps
The authors called for studies to assess the PCL-5 among large numbers of patients to verify the study’s findings.
Reference
Arora, IH, et al. Establishing the validity of a diagnostic questionnaire for childbirth-related post-traumatic stress disorder. American Journal of Obstetrics and Gynecology. 2023.
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