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

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Abstract
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.Design A prospective longitudinal study.Setting Pregnant women in Linköping and Kalmar, Sweden.Population 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.Main outcome measures 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.

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