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Cited by 34Maternal Mental Health During Pregnancy and PostpartumInfant Development and Preterm CareMaternal and Perinatal Health Interventions

Does Birth-Related Trauma Last? Prevalence and Risk Factors for Posttraumatic Stress in Mothers and Fathers of VLBW Preterm and Term Born Children 5 Years After Birth

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Barthel, Dana, Göbel, Ariane, Barkmann, Claus, Helle, Nadine, Bindt, Carola·2020·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2020.575429PMC PMC7769835
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Abstract

Previous research suggests that the birth of a preterm child with very low birth weight (VLBW; <1,500 g) can be traumatic for both parents and lead to short-term consequences like clinical levels of posttraumatic stress symptoms (PTSS) or even to the development of a Posttraumatic Stress Disorder (PTSD). However, little is known about possible mid- and long-term psychological consequences in affected parents. The purpose of this study were (a) to examine the prevalence of parental birth-related PTSS and PTSD in a group of parents with VLBW preterm infants compared to parents of full-term infants 5 years after birth and (b) to investigate potential associations with risk factors for parental PTSS at 5 years postpartum. Perinatal factors (VLBW preterm or term, perceived stress during birth), psychological factors (perceived social support and PTSS 4–6 weeks postpartum, psychiatric lifetime diagnosis) and sociodemographic characteristics (number of children, singleton or multiple birth, socio-economic status), were included in the analysis. The sample consisted of 144 families (77 VLBW, 67 term birth) who participated in the prospective longitudinal cohort study “Hamburg study of VLBW and full-term infant development” (HaFEn-study) and were initially recruited at three perinatal care centers in Hamburg, Germany. PTSD prevalence and PTSS of mothers and fathers were assessed with the Impact of Event Scale-Revised (IES-R), social support with the Questionnaire of Social Support (SOZU-K-22), and lifetime psychiatric diagnoses with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Data were analyzed by hierarchic multiple regression analyses. Results showed that 5 years after birth none of the parents fulfilled the criteria for a birth-related PTSD diagnosis. For mothers, postnatal PTSS and a VLBW preterm birth significantly predicted PTSS 5 years postpartum. For fathers, psychiatric lifetime diagnosis and postnatal PTSS significantly predicted PTSS 5 years after birth. Early identification of parents with higher risk of PTSS, especially after VLBW preterm birth, and their clinical needs seems beneficial to reduce the risk of long-term consequences. More research is needed on the paternal perspective and on potential effects of preterm birth on both parents and their children's mental health outcomes.

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  • Two studies used the DSM-IV and the ICD-10 as diagnostic tools for clinical PTSD.

    “Two studies used the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and the ICD-10 (WHO, 1993) as diagnostic tools for clinical PTSD (Barthel et al., 2020; Misund et al., 2013).”

    From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Barthel et al., 2020

    In Materials and Methods > Variables and Instruments, Barthel et al. report using a DSM-IV-based SCID for psychiatric lifetime diagnoses, including PTSD, and a DSM-IV-based IES-R with a cutoff to screen for PTSD. The Discussion > Limitations clarifies that PTSD prevalence was not assessed by structured clinical interview but by the IES-R cutoff. ICD-10 appears in the Introduction as background on differing diagnostic criteria, not as a tool used in this study; the other cited study cannot be judged from this source. (LLM, conf=0.84)

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  • Fathers of VPT infants were found to experience more PTSS symptoms than fathers of FT infants five years post-partum.

    “Furthermore, a study showed that fathers of VPT were found to expe rience more PTSS symptoms than fathers of FT five years post-partum (Barthel et al., 2020).”

    From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Barthel et al., 2020

    Table 2 (Results, ‘Prevalence of PTSD and PTSS 5 Years Postpartum’; page unavailable) reports higher mean PTSS at five years for fathers in the VLBW preterm group than for fathers in the term group (6.67 versus 4.20). The study defines its group by very low birth weight and prematurity, not strictly by very preterm birth; the Discussion also says infant birth status was not a relevant predictor of fathers’ PTSS after adjustment. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Barthel et al. (2020) found higher PTSS scores in VPT mothers compared with FT mothers five years postpartum, while controlling for socioeconomic status and social support (n=77).

    “Finally, beyond two years, Barthel et al. (2020) compared mothers of VPT and FT five years postpartum and found higher PTSS scores in VPT mothers, while controlling for socioeconomic status and social support ( n = 77).”

    From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Barthel et al., 2020

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Lifetime history with PTSD and PTSS evaluated at birth predicted PTSS symptoms at five years in fathers.

    “Similar to what was found for mothers, lifetime history with PTSD (i.e. clinical diagnosis) and PTSS evaluated at birth predicted symptoms at five years (Barthel et al., 2020, n = 77).”

    From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Barthel et al., 2020

    The Results report that fathers with a psychiatric lifetime diagnosis and higher PTSS at T1 had higher PTSS at five years. But the Methods define that lifetime-diagnosis measure to include several psychiatric disorders, not specifically PTSD, and place the T1 PTSS assessment 4–6 weeks postpartum rather than at birth. The Results also note that the lifetime-diagnosis effect became insignificant in a complete-case sensitivity analysis. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • In mothers of very preterm infants, post-traumatic stress symptoms (PTSS) are prevalent in the first two years following birth and up to five years after it.

    “In mothers of VPT infants, PTSS are prevalent in the first two years following birth and up to five years after it (Barthel et al., 2020; Cam bonie et al., 2017; Greene et al., 2019; Hall et al., 2017; Misund et al., 2013; Rodríguez et al., 2020; Turpin et al., 2019).”

    From Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings (2024) · cites this paper as Barthel et al., 2020

    The Introduction describes elevated maternal PTSS in the early postnatal period and cites findings extending through 18 months and 2–3 years. The Discussion finds higher PTSS in mothers of VLBW infants than in mothers of term infants at five years, but says average levels were quite low and the long-term burden may affect only some women. Thus, describing PTSS as broadly prevalent through five years overstates this paper's finding; its study population was defined by very low birth weight, not strictly by very preterm birth. (LLM, conf=0.88)

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Authors
Barthel, D., Göbel, A., Barkmann, C., Helle, N., & Bindt, C.
Affiliations
University Medical Center Hamburg-Eppendorf (DE)
Corresponding author
Barthel, Dana
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2020-12-15
Volume
11
Pages
575429-575429
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2020.575429
PMC
PMC7769835
OpenAlex
W3111170129
Cited by
34
References
4
Citations by year
2026: 3 · 2025: 11 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 4
FWCI
3.00
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Werner Otto Stiftung
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
post-traumatic stress disorder, posttraumatic stress symptoms, very low birth weight infants, preterm birth, parental mental health, mothers, fathers, risk factors, social support, perinatal stress, long-term psychological effects

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