Risk factors in pregnancy for post-traumatic stress and depression after childbirth

BJOG. 2009 Apr;116(5):672-80. doi: 10.1111/j.1471-0528.2008.02083.x. Epub 2009 Feb 10.


Objective: The objective of this study was to find risk factors in pregnancy for post-traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post-traumatic stress and depression was explored.

Design: A prospective longitudinal study.

Setting: Pregnant women in Linköping and Kalmar, Sweden.

Population: A total of 1224 women were assessed in pregnancy, week 12-20 and 32, as well as 1 month postpartum.

Methods: Post-traumatic stress and depression after delivery were assessed 1 month postpartum. Potential risk factors were assessed in early and late pregnancy. Variables measured during pregnancy were trait anxiety, depression, fear of childbirth, childbirth-related traumatic stress, stress coping capacity, social support, parity, educational level, age, gestation week, parity, educational level, civil status, previous psychological/psychiatric counselling, and previous experience of any traumatic events. Delivery mode was assessed from the medical records.

Main outcome measures: Prevalence of post-traumatic stress (criteria A, B, C, D, E, and F according to DSM-IV) and depression (Beck's depression inventory).

Results: One month postpartum, 12 (1.3%) women had post-traumatic stress (met symptom criteria B, C, and D for post-traumatic stress disorder according to Diagnostic and statistical manual of mental disorders, 4th edition [DSM-IV]). The most important risk factors in pregnancy were depression in early pregnancy (OR=16.3), severe fear of childbirth (OR=6.2), and 'pre'-traumatic stress (in view of the forthcoming delivery) in late pregnancy (OR=12.5). The prevalence of depression was 5.6%. Post-traumatic stress and depression were positively related 1 month postpartum and were predicted by mainly the same factors.

Conclusions: Risk factors for post-traumatic stress and depression after childbirth can be assessed in early pregnancy. Post-traumatic stress and depression also seem to share the same underlying vulnerability factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Adolescent
  • Adult
  • Anxiety / psychology
  • Case-Control Studies
  • Chi-Square Distribution
  • Delivery, Obstetric / psychology
  • Depression / complications
  • Depression, Postpartum / etiology*
  • Fear / psychology
  • Female
  • Humans
  • Odds Ratio
  • Parturition / psychology*
  • Pregnancy
  • Pregnancy Complications / psychology
  • Pregnancy Trimester, First
  • Pregnancy Trimester, Third
  • Prospective Studies
  • Psychometrics
  • Risk Factors
  • Stress Disorders, Post-Traumatic / etiology
  • Young Adult