Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors
Abstract
Background Although longitudinal trajectories of post-traumatic stress disorder (PTSD) are well-established in general trauma populations, very little is known about the trajectories of birth-related PTSD. This study aimed to identify trajectories of birth-related PTSD; determine factors associated with each trajectory; and identify women more likely to develop birth-related PTSD.Method 226 women who had traumatic childbirth according to DSM-IV criterion A were drawn from a community sample of 950 women. Measures were taken of PTSD, affective symptoms, fear of childbirth and social support in pregnancy, 4-6 weeks and 6-months postpartum. Information on some obstetric and psychosocial factors were also prospectively obtained.Results Four trajectories were identified: resilience (61.9%), recovery (18.5%), chronic-PTSD (13.7%) and delayed-PTSD (5.8%). Resilience was consistently distinguished from other PTSD trajectories by less affective symptoms at 4-6 weeks postpartum. Poor satisfaction with health professionals was associated with chronic-PTSD and delayed-PTSD. When affective symptoms at 4-6 weeks postpartum were removed from the model, less social support and higher fear of childbirth 4-6 weeks after birth predicted chronic and recovery trajectories; whereas experience of further trauma and low levels of satisfaction with health professionals were predictive of chronic-PTSD and delayed-PTSD, compared to resilience. Additional variables associated with different trajectories included antenatal affective symptoms, caesarean-section, preterm birth and receiving professional help.Limitations Use of self-report measures, use of DSM-IV criteria for PTSD diagnosis, and no follow-up beyond six months are the main limitations of this study.Conclusion Identified factors may inform preventive and treatment interventions for women with traumatic birth experiences.
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Improving resilience has been shown to prevent the development and recurrence of depression and other adverse outcomes such as PTSD.
“while improving resilience has shown to prevent the development and recurrence of depression and other adverse outcomes such as PTSD [12, 27].”
From Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort. (2020) · cites this paper as [27]
The Results (section 2.4, page unavailable) compare observed resilient and non-resilient PTSD trajectories, and the Discussion (section 3, page unavailable) links postpartum affective symptoms with later PTSD. Neither reports that improving resilience prevents depression, its recurrence, or PTSD. Searches for resilience-improving interventions and prevention found no such finding in our copy. (LLM, conf=0.76)
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- Authors
- Dikmen-Yildiz, P., Ayers, S., & Phillips, L.
- Affiliations
- City, University of London (GB)
- ORCID
- Ayers, Susan
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 229
- Pages
- 377-385
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2781643719
- Cited by
- 146
- References
- 43
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 21 · 2023: 18 · 2022: 30 · 2021: 15 · 2020: 14 · 2019: 12 · 2018: 3 · 2017: 1
- FWCI
- 12.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Funders
- Ministry of National Education of the Republic of Turkey
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- post-traumatic stress disorder, traumatic birth, PTSD trajectories, resilience, chronic PTSD, postpartum period, affective symptoms, fear of childbirth, cesarean section, preterm birth, risk factors
- MeSH terms
- Adult, Fear, Female, Humans, Longitudinal Studies, Pregnancy, Prognosis, Risk Factors, Social Support, Stress Disorders, Post-Traumatic, Parturition, Postpartum Period, Young Adult
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