Journal of affective disorders · 2026
Early prediction of childbirth-related posttraumatic stress disorder symptoms.
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Allouche-Kam Hadas, Arora Isha Hemant, Lee Mary C, Felsenstein Tal Elhasid, Hughes Francine, Dekel Sharon
Аннотация
BACKGROUND: Medically complicated childbirth is associated with increased risk of childbirth-related posttraumatic stress disorder (PTSD), yet mechanisms linking complications to persistent PTSD symptoms remain poorly understood.
METHODS: A total of 667 women were followed from pregnancy through 6 months postpartum in a prospective longitudinal study. Acute childbirth-related distress was assessed during the immediate postpartum hospitalization using the Peritraumatic Distress Inventory. Childbirth-related PTSD symptoms were assessed at approximately 10 days, 2 months, and 6 months postpartum using the PTSD Checklist for DSM-5. Obstetric information was extracted from electronic medical records. Structural equation modeling examined pathways linking medically complicated childbirth, acute distress, early postpartum PTSD symptoms, postpartum depression, and subsequent PTSD symptoms.
RESULTS: Medically complicated childbirth was related to later childbirth-related PTSD symptoms through sequential pathways. Complications predicted greater acute distress (β = 0.292, p < 0.001), which was strongly associated with PTSD symptoms at approximately 10 days postpartum (β = 0.561, p < 0.001). The serial indirect pathway to 2-month PTSD through acute distress and early PTSD symptoms was significant (B = 1.96, 95% CI [1.15, 2.98], p < 0.001). This pathway extended to 6 months through acute distress, early PTSD symptoms, and 2-month PTSD symptoms (B = 0.82, 95% CI [0.35, 1.48], p = 0.005). Direct effects of obstetric complications were nonsignificant, and postpartum depression did not mediate these associations.
CONCLUSIONS: Medically complicated childbirth may contribute to persistent childbirth-related PTSD through heightened acute distress and the subsequent progression of trauma-related symptoms, highlighting the immediate and early postpartum periods as important windows for risk identification.
METHODS: A total of 667 women were followed from pregnancy through 6 months postpartum in a prospective longitudinal study. Acute childbirth-related distress was assessed during the immediate postpartum hospitalization using the Peritraumatic Distress Inventory. Childbirth-related PTSD symptoms were assessed at approximately 10 days, 2 months, and 6 months postpartum using the PTSD Checklist for DSM-5. Obstetric information was extracted from electronic medical records. Structural equation modeling examined pathways linking medically complicated childbirth, acute distress, early postpartum PTSD symptoms, postpartum depression, and subsequent PTSD symptoms.
RESULTS: Medically complicated childbirth was related to later childbirth-related PTSD symptoms through sequential pathways. Complications predicted greater acute distress (β = 0.292, p < 0.001), which was strongly associated with PTSD symptoms at approximately 10 days postpartum (β = 0.561, p < 0.001). The serial indirect pathway to 2-month PTSD through acute distress and early PTSD symptoms was significant (B = 1.96, 95% CI [1.15, 2.98], p < 0.001). This pathway extended to 6 months through acute distress, early PTSD symptoms, and 2-month PTSD symptoms (B = 0.82, 95% CI [0.35, 1.48], p = 0.005). Direct effects of obstetric complications were nonsignificant, and postpartum depression did not mediate these associations.
CONCLUSIONS: Medically complicated childbirth may contribute to persistent childbirth-related PTSD through heightened acute distress and the subsequent progression of trauma-related symptoms, highlighting the immediate and early postpartum periods as important windows for risk identification.