A model of risk for perinatal posttraumatic stress symptoms
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ORIGINAL ARTICLE
A model of risk for perinatal posttraumatic stress symptoms Rebecca Grekin 1,2
&
Michael W. O’Hara 1 & Rebecca L. Brock 3
Received: 18 September 2019 / Accepted: 23 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Existing research suggests that childbirth may be a significant trigger of posttraumatic stress symptoms (PTSS). The current study examined whether subjective birthing experiences and objective childbirth characteristics mediated the association between predisposing psychosocial factors measured during pregnancy (e.g., fear of childbirth, history of trauma, and social support) and PTSS during the postpartum period. Women were recruited during pregnancy from a large Midwestern hospital. Symptoms of posttraumatic stress, obsessive compulsive disorder (OCD), and depression, as well as PTSS-related risk factors, including social support, lifetime trauma exposure, fear of childbirth, subjective perceptions, and objective characteristics of childbirth, were measured during pregnancy and 4, 8, and 12 weeks postpartum. A path model revealed that subjective perceptions of childbirth mediated the association between fear of childbirth and PTSS at 4 weeks postpartum. Objective childbirth characteristics mediated the association between fear of childbirth and PTSS at 8 weeks postpartum, and there was a direct association between fear of childbirth and PTSS. Subjective perceptions of childbirth also mediated the effect of fear of childbirth on PTSS at 4 weeks postpartum when controlling for OCD symptoms. Further, the direct effect of fear of childbirth on PTSS at 8 weeks postpartum remained significant when controlling for OCD symptoms. The current study emphasizes the importance of fear of childbirth and subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these models in diverse and at-risk samples. Valid assessments and effective interventions for perinatal PTSS should be explored. Keywords Perinatal posttraumatic stress . Fear of childbirth . Subjective birth experiences
Recent research suggests that childbirth may be a significant trigger of posttraumatic stress symptoms (PTSS) in women. Meta-analyses estimate that 3–15% of women meet the criteria for posttraumatic stress disorder (PTSD) in the postpartum period, depending on the type of sample (Ayers et al. 2016; Dekel et al. 2017; Grekin and O’Hara 2014; Yildiz et al.
* Rebecca Grekin [email protected]
2017). Notably, a significant proportion of women identify childbirth as traumatic, meeting the DSM-IV criteria for trauma1 (Alcorn et al. 2010; American Psychiatric Association 2000; Boorman et al. 2014), and though women may not meet full criteria for the disorder, they subsequently present with clinically significant PTSS that affect overall functioning and well-being (Parfitt and Ayers 2009). Studies strongly suggest that both negative subjective perceptions and objectively high-risk characteristics of childbirth are robustly ass
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