title: Testing a cognitive model to predict posttraumatic stress disorder following childbirth.
abstract: One third of women describes their childbirth as traumatic and between 0.8 and 6.9% goes on to develop posttraumatic stress disorder (PTSD). The cognitive model of PTSD has been shown to be applicable to a range of trauma samples. However, childbirth is qualitatively different to other trauma types and special consideration needs to be taken when applying it to this population. Previous studies have investigated some cognitive variables in isolation but no study has so far looked at all the key processes described in the cognitive model. This study therefore aimed to investigate whether theoretically-derived variables of the cognitive model explain unique variance in postnatal PTSD symptoms when key demographic, obstetric and clinical risk factors are controlled for.
  
  
  
  One-hundred and fifty-seven women who were between 1 and 12 months post-partum (M = 6.5 months) completed validated questionnaires assessing PTSD and depressive symptoms, childbirth experience, postnatal social support, trauma memory, peritraumatic processing, negative appraisals, dysfunctional cognitive and behavioural strategies and obstetric as well as demographic risk factors in an online survey.
  
  
  
  A PTSD screening questionnaire suggested that 5.7% of the sample might fulfil diagnostic criteria for PTSD. Overall, risk factors alone predicted 43% of variance in PTSD symptoms and cognitive behavioural factors alone predicted 72.7%. A final model including both risk factors and cognitive behavioural factors explained 73.7% of the variance in PTSD symptoms, 37.1% of which was unique variance predicted by cognitive factors.
  
  
  
  All variables derived from Ehlers and Clark's cognitive model significantly explained variance in PTSD symptoms following childbirth, even when clinical, demographic and obstetric were controlled for. Our findings suggest that the CBT model is applicable and useful as a way of understanding and informing the treatment of PTSD following childbirth.
authors.affiliation: The Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK.
authors.forename: Lydia
authors.initials: L
authors.lastname: King
authors.affiliation: Department of Clinical Health Psychology, Warwick Hospital, Lakin Rd, Warwick, CV34 5BW, UK.
authors.forename: Kirstie
authors.initials: K
authors.lastname: McKenzie-McHarg
authors.affiliation: Department of Maternal and Child Health, University Hospital Lausanne, Avenue Pierre-Decker 2, CH-1011, Lausanne, Switzerland. antje.horsch@chuv.ch.
authors.forename: Antje
authors.identifier: 0000-0002-9950-9661
authors.initials: A
authors.lastname: Horsch
mesh_terms: D000328:Adult; D003071:Cognition; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D006801:Humans; D008960:Models, Psychological; D036801:Parturition / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011644:Puerperal Disorders / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Childbirth; Cognitive model; Cognitive predictors; PTSD; Postnatal; Risk factors; Traumatic