title: Predisposing and Precipitating Factors for Dissociation During Labor in a Cohort Study of Posttraumatic Stress Disorder and Childbearing Outcomes.
abstract: BACKGROUND
  Peritraumatic dissociation is an important predictor of posttraumatic stress disorder (PTSD), depression, and impaired bonding following childbirth. The purpose of this study was to follow up on an earlier finding that peritraumatic dissociation in labor was associated with adverse postpartum outcomes by identifying predictors of dissociation in labor.
  
  
  METHODS
  This analysis used data from a prospective cohort study of primiparous women from southeast Michigan. There were 564 women included in the analysis; the primary outcome measure was the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) score measuring dissociation during labor.
  
  
  RESULTS
  The prevalence of dissociation in labor for this sample was 7.4%. Important predictors of dissociation in labor included both predisposing (eg, childhood maltreatment trauma, preexisting psychopathology) and precipitating (eg, perception of care, negative appraisal of labor) factors. Overall, these predictors explained 14.7% of variance in PDEQ score. In 3 separate, simple linear regression models, the PDEQ score explained 20% of variance in postpartum PTSD, 13% of variance in postpartum depression, and 9% of variance in impaired bonding.
  
  
  CONCLUSIONS
  Women with maltreatment history and PTSD are at risk to be retraumatized or overwhelmed by birth and to dissociate. Although it would be optimal to assess for dissociative coping prenatally, assessing with the PDEQ following birth could contribute to evaluation of risk for postpartum psychopathology.
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Choi
authors.forename: Julia S
authors.initials: JS
authors.lastname: Seng
mesh_terms: D000328:Adult; D003863:Depression / Q000209:etiology; D019052:Depression, Postpartum / Q000209:etiology; D004213:Dissociative Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology*; D016014:Linear Models; D008824:Michigan / Q000453:epidemiology; D009769:Object Attachment; D007744:Obstetric Labor Complications / Q000523:psychology*; D049590:Postpartum Period; D015985:Precipitating Factors; D011247:Pregnancy; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D055815:Young Adult
keywords: childhood maltreatment; dissociation; intrapartum care; mental health disorders; posttraumatic stress; survey research