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


METHODS
A prospective longitudinal study.


METHODS
Pregnant women in Linköping and Kalmar, Sweden.


METHODS
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.


METHODS
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.
Söderquist
J
J
Department of Welfare and Social Studies (ISV), Linköping University, Campus Norrköping, Norrköping, Sweden. johso@isv.liu.se
Wijma
B
B
Thorbert
G
G
Wijma
K
K
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D036861:Delivery, Obstetric / Q000523:psychology; D003863:Depression / Q000150:complications; D019052:Depression, Postpartum / Q000209:etiology*; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D016017:Odds Ratio; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology; D011261:Pregnancy Trimester, First; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D011594:Psychometrics; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D055815:Young Adult