Maintaining factors of posttraumatic stress symptoms following childbirth: A population-based, two-year follow-up study

Susan Garthus-Niegel; Susan Ayers; Tilmann von Soest; Leila Torgersen; Malin Eberhard-Gran

doi:10.1016/j.jad.2014.10.003

Maintaining factors of posttraumatic stress symptoms following childbirth: A population-based, two-year follow-up study

J Affect Disord. 2015 Feb 1:172:146-52. doi: 10.1016/j.jad.2014.10.003. Epub 2014 Oct 14.

Authors

Susan Garthus-Niegel¹, Susan Ayers², Tilmann von Soest³, Leila Torgersen⁴, Malin Eberhard-Gran⁵

Affiliations

¹ Institute and Policlinic of Occupational and Social Medicine, TU Dresden, Faculty of Medicine, Fetscherstr. 74, 01307 Dresden, Germany; Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway. Electronic address: susan.garthus-niegel@tu-dresden.de.
² Centre for Maternal and Child Health, School of Health Sciences, City University London, London, UK.
³ Department of Childhood, Development, and Cultural Diversity, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Norway.
⁴ Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway.
⁵ Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Norway.

PMID: 25451409
DOI: 10.1016/j.jad.2014.10.003

Abstract

Background: Previous research has established a number of risk factors that are associated with the onset of PTSD following childbirth. However, little is known about factors that maintain PTSD symptoms.

Methods: This study is part of the Akershus Birth Cohort. Questionnaire data from pregnancy week 17, 8 weeks postpartum and 2 years postpartum were used. 1473 women completed all these three questionnaires and were included in the analyses. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Potential maintaining factors were personality, sleep, support and life events. The factors that were significantly correlated with post-traumatic stress symptoms were entered into regression analyses. Mediation analyses were run to test whether significant predictors would serve as mediator of post-traumatic stress symptoms at 8 weeks postpartum to post-traumatic stress symptoms at 2 years postpartum.

Results: We found several low to moderate associations between maintaining factors and PTSD symptoms two years postpartum. Adjusting for the starting point - PTSD symptoms 8 weeks postpartum - only insomnia remained significantly associated. Further, insomnia mediated a small portion of the effect of PTSD symptoms 8 weeks postpartum to PTSD symptoms 2 years postpartum.

Limitations: Limitations of the study include a relative homogeneous sample, modest effect sizes, low internal consistency of some of the measures and the challenge to distinguish insomnia from PTSD symptoms.

Conclusions: Treatment of postpartum PTSD might benefit from addressing insomnia if present. Alleviating insomnia may itself reduce daytime symptoms of PTSD and it may also increase the efficacy of primary PTSD treatments.

Keywords: Akershus Birth Cohort; Maintaining factors; Posttraumatic stress symptoms following childbirth.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Conflict, Psychological
Confounding Factors, Epidemiologic
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Interpersonal Relations*
Life Change Events*
Parturition / psychology*
Personality*
Postpartum Period*
Pregnancy
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Risk Factors
Self Report
Sleep Initiation and Maintenance Disorders / psychology
Sleep*
Stress Disorders, Post-Traumatic / etiology*