title: Aetiological relationships between factors associated with postnatal traumatic symptoms among Japanese primiparas and multiparas: A longitudinal study.
abstract: OBJECTIVE
  this study aims to identify the aetiological relationships of psychosocial factors in postnatal traumatic symptoms among Japanese primiparas and multiparas.
  
  
  METHODS
  a longitudinal, observational survey.
  
  
  METHODS
  participants were recruited at three institutions in Tokyo, Japan between April 2013 and May 2014. Questionnaires were distributed to 464 Japanese women in late pregnancy (> 32 gestational weeks, Time 1), on the third day (Time 2) and one month (Time 3) postpartum.
  
  
  METHODS
  The Japanese Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version A was used to measure antenatal fear of childbirth and social support, while the Impact of Event Scale Revised (IES-R) measured traumatic stress symptoms due to childbirth.
  
  
  RESULTS
  of the 464 recruited, 427 (92%) completed questionnaires at Time 1, 358 (77%) completed at Time 2, and 248 (53%) completed at Time 3. Total 238 (51%) were analysed. A higher educational level has been identified in analysed group (p=0.021) Structural equation modelling was conducted separately for primiparas and multiparas and exhibited a good fit. In both groups antenatal fear of childbirth predicted Time 2 postnatal traumatic symptoms (β=0.33-0.54, p=0.002-0.007). Antenatal fear of childbirth was associated with a history of mental illness (β=0.23, p=0.026) and lower annual income (β =-0.24, p=0.018). Among multiparas, lower satisfaction with a previous delivery was related to antenatal fear of childbirth (β =-0.28, p < 0.001).
  
  
  CONCLUSIONS
  antenatal fear of childbirth was a significant predictor of traumatic stress symptoms after childbirth among both primiparous and multiparous women. Fear of childbirth was predicted by a history of mental illness and lower annual income for primiparous women, whereas previous birth experiences were central to multiparous women.
  
  
  CONCLUSIONS
  the association between antenatal fear of childbirth and postnatal traumatic symptoms indicates the necessity of antenatal care. It may be important to take account of the background of primiparous women, such as a history of mental illness and their attitude towards the upcoming birth. For multiparous women, focusing on and helping them to view their previous birth experiences in a more positive light are vital tasks for midwives.
authors.affiliation: Department of Paediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-city, Nagasaki 852-8523, Japan.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Takegata
authors.affiliation: Department of Midwifery and Women's Health, Division of Health Sciences & Nursing Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address: mharuna-tky@umin.ac.jp.
authors.forename: Megumi
authors.initials: M
authors.lastname: Haruna
authors.affiliation: Department of Midwifery and Women's Health, Division of Health Sciences & Nursing Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Matsuzaki
authors.affiliation: Department of Midwifery and Women's Health, Division of Health Sciences & Nursing Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Mie
authors.initials: M
authors.lastname: Shiraishi
authors.affiliation: Centre of Physical and Mental Health, Mie University, 1577 Kurimachiya-cho, Tsu City, Mie 514-8507, Japan.
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okano
authors.affiliation: Centre for Women's, Family & Child Health, Department of Nursing Science, Faculty of Health Sciences, University College of Southeast Norway, P.O. Box 235, N-3603 Tønsberg, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Severinsson
mesh_terms: D000328:Adult; D005239:Fear / Q000523:psychology; D005260:Female; D020073:Gravidity; D006801:Humans; D007564:Japan; D008016:Life Change Events; D008137:Longitudinal Studies; D008603:Mental Health / Q000592:standards*; D036801:Parturition / Q000523:psychology; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology / Q000592:standards*; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000209:etiology* / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology*; D011795:Surveys and Questionnaires
keywords: Birth parity; Factors; Fear of childbirth; Japanese women; Traumatic stress symptoms