A single center cross-sectional study examining the prevalence of inpatient postpartum anxiety and post-traumatic stress symptoms using the State-Trait Anxiety Inventory and Post-Traumatic Stress Disorder Checklist for DSM-5.

BACKGROUND

Mental health conditions are now the leading cause of maternal mortality in the United States, prompting calls for universal postpartum anxiety and post-traumatic stress disorder screening. However, standardized guidelines for screening implementation remain deficient. This cross-sectional study evaluated the prevalence of inpatient postpartum anxiety and post-traumatic stress disorder while exploring associated risk factors.

OBJECTIVES

Over a three-week period, we prospectively assessed adult postpartum patients following all delivery modes (vaginal and cesarean, live and stillbirth) at a single academic institution in the US. Screening was performed within 36 hours of delivery using the State-Trait Anxiety Inventory (score cut off ≥80) and post-traumatic stress disorder checklist for DSM-5 (score cut off ≥28). Data collection included demographic, medical, anesthesia, obstetric and neonatal variables, with assessments conducted in-person or via telephone for any spoken language.

STUDY

DESIGN

Cross-sectional study.

RESULTS

Among 275 eligible patients, 263 (95.6%) completed the screening measures. The prevalence of positive postpartum anxiety and post-traumatic stress disorder screening was 12.5% and 4.9% respectively, with 3.8% of patients screening positive for both conditions. Worse State-Trait Anxiety Inventory scores were associated with ASA ≥3, pre-term birth and neonatal Apgar scores at 5 minutes <7. Worse post-traumatic stress disorder scores were associated with ASA ≥3, primiparity, spontaneous vaginal delivery, pre-eclampsia, pre-term birth, blood transfusion, Apgar score <7 and neonatal intensive care unit admission. Factors after adjustment associated with positive anxiety screening were a psychiatric history or medication use. No factors after adjustment were associated with positive PTSD screening.

CONCLUSIONS

Positive screening for inpatient postpartum anxiety was two and a half times more prevalent than for post-traumatic stress disorder. Positive anxiety screening was independently associated with psychiatric history or medication use. Targeted screening for post-traumatic stress disorder may be more appropriate, particularly among patients with pre-existing psychiatric conditions, complicated pregnancies or neonatal morbidity. Future research should focus on determining optimal screening parameters and timing, and intervention guidelines to better support high-risk obstetric populations.