PTSD, risk factors, and expectations among women having a baby : a two-wave longitudinal study

Introduction. The aim of the study was to evaluate the incidence of chronic post-traumatic stress disorder (PTSD) after childbirth in relation to pre-partum variables (personality characteristics, anamnestic risk factors) and intra-partum obstetrical and neonatal variables. Since expectations before an event could modify the perceptions, reactions, and satisfaction afterward, the representations of the idealized delivery were carefully analyzed. Moreover, the real and desired help perception from physicians and family members were separately considered during pregnancy and after delivery in relation to PTSD. Method. The study was carried out submitting a questionnaire to pregnant women twice: firstly when women were in their 38 << 42 gestational week (Time 1) and secondly after 3-6 months from childbirth (Time 2). 93 women were recruited at a University City Hospital in Milan, Italy. PTSD subscales, depression, and anxiety levels were also assessed. Results. 2.4% of women had a complete PTSD, while 32.1% of them resulted in having one or two positive subscales of symptoms: 15.5% ( N= 13) had a positive intrusion subscale, 25.0% ( N= 21) had a positive arousal subscale, while only 3.6% ( N= 3) had a positive avoidance subscale. Pre-delivery depression influences PTSD, but only for the intrusion subscale. Pre-delivery physical risk factors are linked to PTSD on the avoidance subscale. At Time 2 depression and PTSD are often present simultaneously. Given the high percentage of healthy newborns, intra-partum obstetrical variables do not seem to influence PTSD. High trait anxiety distinctively coexists with a specific expected delivery and a 'deception' in desired and real support from professionals. Conclusions. Childbirth is a risk condition for PTSD, depression during pregnancy influences the intrusion subscale, while having physical problems influences the arousal subscale. Expectations and support are modulated by the anxiety levels and they are not directly related to chronic PTSD. (copyright) 2006 Taylor & Francis.