title: Interplay of demographic variables, birth experience, and initial reactions in the prediction of symptoms of posttraumatic stress one year after giving birth.
abstract: BACKGROUND
  There has been increasing research on posttraumatic stress disorder (PTSD) following childbirth in the last two decades. The literature on predictors of who develops posttraumatic stress symptoms (PSS) suggests that both vulnerability and birth factors have an influence, but many studies measure predictors and outcomes simultaneously.
  
  
  OBJECTIVE
  In this context, we aimed to examine indirect and direct effects of predictors of PSS, which were measured longitudinally.
  
  
  METHODS
  We assessed women within the first days (n=353), 6 weeks, and 12 months (n=183) after having given birth to a healthy infant. The first assessment included questions on demographics, pregnancy, and birth experience. The second and third assessments contained screenings for postpartum depression, PTSD, and general mental health problems, as well as assessing social support and physical well-being. We analysed our data using structural equation modelling techniques (n=277).
  
  
  RESULTS
  Our final model showed good fit and was consistent with a diathesis-stress model of PSS. Women who had used antidepressant medication in the 10 years before childbirth had higher PSS at 6 weeks, independent of birth experiences. Subjective birth experience was the early predictor with the highest total effect on later PSS. Interestingly, a probable migration background also had a small but significant effect on PSS via more episiotomies. The null results for social support may have been caused by a ceiling effect.
  
  
  CONCLUSIONS
  Given that we measured predictors at different time points, our results lend important support to the etiological model, namely, that there is a vulnerability pathway and a stress pathway leading to PSS. PSS and other psychological measures stayed very stable between 6 weeks and 1 year postpartum, indicating that it is possible to identify women developing problems early.
  Our results are consistent with a diathesis-stress model: vulnerability (antidepressant use in the previous 10 years) influenced posttraumatic stress symptoms at 6 weeks and 1 year, independently of stress (birth-related variables). The strongest predictor of posttraumatic stress symptoms 1 year postpartum was posttraumatic stress symptoms 6 weeks postpartum. This means that women who develop problems could be identified during routinely offered postpartum care. Women with a probable migration background experienced more PSS 1 year after the birth, which was an indirect effect through more episiotomies and more PSS after 6 weeks.
authors: Lehrstuhl für Klinische und Biologische Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Germany; julia.koenig@ku.de.
authors: Julia
authors: J
authors: König
authors: Klinikum Ingolstadt, Ingolstadt, Germany.
authors: Sabine
authors: S
authors: Schmid
authors: Refugio München, München, Germany.
authors: Eva
authors: E
authors: Löser
authors: Städtisches Klinikum München, Klinikum Schwabing, München, Germany.
authors: Olaf
authors: O
authors: Neumann
authors: Caritas-Krankenhaus St. Josef, Regensburg, Germany.
authors: Stefan
authors: S
authors: Buchholz
authors: Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany.
authors: Ralph
authors: R
authors: Kästner
keywords: Childbirth; aetiology; posttraumatic stress; predictors; structural equation modelling