Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study.
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Handelzalts Jonathan E, Ayers Susan, Webb Rebecca, Constantinou Georgina, Lucas Grace, Grollman Christopher, Ohayon Shay, Awad Sirhan Natalia, Baird Kathleen, Baldisserotto Márcia, Batool Ramish, Batool Shahida, Caparros-Gonzalez Rafael A, Chorwe-Sungani Genesis, Christoforou Andri, Coo Soledad, Costa Raquel, Dikmen-Yildiz Pelin, Ďuríčeková Barbora, Dušová Bohdana, Enea Violeta, Garthus-Niegel Susan, Grundström Hanna, Gureje Oye, Hadjigeorgiou Eleni, Haga Silje Marie, Horsch Antje, Ionio Chiara, Jarašiūnaitė-Fedosejeva Gabija, Jomeen Julie, Kazmierczak Maria, Lalor Joan, Milosavljevic Maja, Nagle Ursula, Nakić Radoš Sandra, Nieminen Katri, Oladeji Bibilola Damilola, Osório Flavia, Pawlicka Paulina, Peled Yoav, Pinto Tiago Miguel, Rattaz Valentine, Riklikienė Olga, Schellong Julia, Sigurðardóttir Valgerður Lísa, Thagunna Narenda Singh, Theme Filha Mariza, Škodová Zuzana, Stebelová Petra, Stepisnik Perdih Tjasa, Stewart Robert, Swift Emma Marie, Uriko Kristiina, Vally Zahir, Vezmar Milica, Zedan Haya H, Žutić Maja, INTERSECT Consortium*
Аннотация
METHODS: The INTERSECT cross-sectional survey (April 2021-January 2024) included 11,302 women at 6-12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant-related factors. All models were adjusted for country-level variation as a random effect.
RESULTS: Models explained substantial variance across all outcomes (conditional R2 = 0.53-0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80-0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41-1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29-2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21-0.29). Other predictors reached significance but showed small effects.
CONCLUSIONS: Findings support a stress-diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women's appraisals of birth.