Childbirth-related posttraumatic stress disorder: definition, risk factors, pathophysiology, diagnosis, prevention, and treatment.

Psychological birth trauma and childbirth-related posttraumatic stress disorder represent a substantial burden of disease with 6.6 million mothers and 1.7 million fathers or co-parents affected by childbirth-related posttraumatic stress disorder worldwide each year. There is mounting evidence to indicate that parents who develop childbirth-related posttraumatic stress disorder do so as a direct consequence of a traumatic childbirth experience. High-risk groups, such as those who experience preterm birth, stillbirth, or preeclampsia, have higher prevalence rates. The main risks include antenatal factors (eg, depression in pregnancy, fear of childbirth, poor health or complications in pregnancy, history of trauma or sexual abuse, or mental health problems), perinatal factors (eg, negative subjective birth experience, operative birth, obstetrical complications, and severe maternal morbidity, as well as maternal near misses, lack of support, dissociation), and postpartum factors (eg, depression, postpartum physical complications, and poor coping and stress). The link between birth events and childbirth-related posttraumatic stress disorder provides a valuable opportunity to prevent traumatic childbirths and childbirth-related posttraumatic stress disorder from occurring in the first place. Childbirth-related posttraumatic stress disorder is an extremely distressing mental disorder and has a substantial negative impact on those who give birth, fathers or co-parents, and, potentially, the whole family. Still, a traumatic childbirth experience and childbirth-related posttraumatic stress disorder remain largely unrecognized in maternity services and are not routinely screened for during pregnancy and the postpartum period. In fact, there are gaps in the evidence on how, when, and who to screen. Similarly, there is a lack of evidence on how best to treat those affected. Primary prevention efforts (eg, screening for antenatal risk factors, use of trauma-informed care) are aimed at preventing a traumatic childbirth experience and childbirth-related posttraumatic stress disorder in the first place by eliminating or reducing risk factors for childbirth-related posttraumatic stress disorder. Secondary prevention approaches (eg, trauma-focused psychological therapies, early psychological interventions) aim to identify those who have had a traumatic childbirth experience and to intervene to prevent the development of childbirth-related posttraumatic stress disorder. Tertiary prevention (eg, trauma-focused cognitive behavioural therapy and eye movement desensitization and reprocessing) seeks to ensure that people with childbirth-related posttraumatic stress disorder are identified and treated to recovery so that childbirth-related posttraumatic stress disorder does not become chronic. Adequate prevention, screening, and intervention could alleviate a considerable amount of suffering in affected families. In light of the available research on the impact of childbirth-related posttraumatic stress disorder on families, it is important to develop and evaluate assessment, prevention, and treatment interventions that target the birthing person, the couple dyad, the parent-infant dyad, and the family as a whole. Further research should focus on the inclusion of couples in different constellations and, more generally, on the inclusion of more diverse populations in diverse settings. The paucity of national and international policy guidance on the prevention, care, and treatment of psychological birth trauma and the lack of formal psychological birth trauma services and training, highlight the need to engage with service managers and policy makers.

Practicable strategies parents can apply in their daily routine to successfully implement the 50/50-split-model of paid work, childcare, and housework: a qualitative content analysis.

BACKGROUND: Many young couples are planning to share paid work, childcare, and housework equally between each other. But implementing such a 50/50-split-model is difficult and parents often return to traditional gender role distributions after the birth of a child. This return has potential negative effects on mental health, physical health, and relationship satisfaction. Therefore, this study aims to find practicable strategies on a behavioral-level which new parents can apply in their daily routine to successfully implement the 50/50-split-model if they wish to do so. METHODS: This qualitative study, DREAMTALK, is part of the multi-method, prospective Dresden Study on Parenting, Work, and Mental Health (DREAM). For DREAMTALK, N = 25 parents implementing a 50/50-split-model were selected based on quantitative data regarding time use, which participants had provided in questionnaires. In DREAMTALK, problem-centered interviews were conducted with the selected sample at 17 months postpartum. Those were analyzed via qualitative content analysis, which is systematic, rule-guided, and based on the criteria of validity and reliability. RESULTS: The qualitative content analysis revealed a catalog of 38 practicable strategies to manage daily routine, which can help parents to successfully implement a 50/50-split-model. Individual participants used 23 success strategies on average. Examples include having a regular coordination appointment with the other parent, planning foresightedly, flexibility, reducing cleaning, optimization of routes, or moderate split-shift parenting. Some of these strategies seem opposing, e.g., planning foresightedly, and at the same time, meeting unpredicted changes with flexibility. Those seemingly opposing strategies were well balanced by the participants, which was an additional strategy. CONCLUSIONS: Parents can use the success strategies relatively independently of external circumstances. This behavioral perspective extends prior theories, which have focused on explaining unequal gender role distributions with external circumstances. A behavioral perspective can be a gateway to assist more parents to pioneer in implementing the 50/50-split-model, which might in turn lead to a healthier and more satisfied public population.

Perineal tear and childbirth-related posttraumatic stress: A prospective cohort study.

OBJECTIVE: Quantitative studies examining the occurrence of childbirth-related posttraumatic stress disorder (CB-PTSD) following severe perineal rupture are lacking. The objective of this population-based study was to investigate the prospective associations between the degree of perineal tear during childbirth and CB-PTSD symptoms, when adjusting for known covariates (maternal age, years of school education, premature birth, and parity). We hypothesized that women with different degrees of perineal tear will differ regarding (1) the level of CB-PTSD symptoms at 8 weeks and 2 years postpartum and (2) the rate of change in CB-PTSD symptoms from 8 weeks to 2 years postpartum. METHOD: Secondary data analysis from the Akershus Birth Cohort, a large population-based prospective cohort study using self-report questionnaires and hospital record data. RESULTS: The degree of perineal tear was significantly associated with CB-PTSD symptoms at 8 weeks and 2 years postpartum. However, the degree of perineal tear was not significantly associated with the change in CB-PTSD symptoms over time. Similar patterns were found for both total CB-PTSD symptoms as well as for avoidance and intrusion symptoms only. CONCLUSION: Results seem to support a dose-response model, suggesting that the higher the severity of the perineal tear, the higher the posttraumatic morbidity.

Impact of the COVID-19 Pandemic On Violence Against Children: A Narrative Review.

PURPOSE OF REVIEW: The goal of this paper was to explore the different ways the COVID-19 pandemic has affected violence against children (VAC). RECENT FINDINGS: Recent research of peer-reviewed articles using operational or survey data revealed the pandemic's impact in terms of institutional responses, risk and mediating factors, changes in VAC dynamics, and a likely increase in child marriage. Findings include a decrease in institutional responses, activities, and prevention case openings; an increased incidence of interparental intimate partner violence (IPV) witnessing cases, hospital admissions for suspected Abusive Head Trauma (AHT), other pediatric injuries, and sexual violence; a change in family conflict dynamics; and an estimated increase in child marriages. It also revealed mediating factors between the relationship of the pandemic and VAC (such as parental stress and mental health symptoms), as well as risk factors observed by service providers, which include the risk of mental health symptoms of both parents and children. Post-pandemic VAC research can be improved by utilizing operational or survey data in a meaningful way to be able to derive sound intervention approaches to diminish the pandemic's impact on VAC and child marriage. We also propose for researchers to integrate child marriage into the definition of VAC.

Validation of the German version of the pregnancy-related anxiety scale (PrAS): psychometric properties across all trimesters of pregnancy.

BACKGROUND: Pregnancy-related anxiety has received greater research attention recently given its association with adverse outcomes (e.g., negative birth experiences). The Pregnancy-related Anxiety Scale (PrAS) offers the possibility to assess pregnancy-related anxiety, but no German version is available. Therefore, the aim of this study was to validate a German version of the PrAS, a comprehensive measure with eight dimensions. METHODS: Pregnant women of any parity or gestation completed an online survey consisting of the PrAS, PRAQ-R2, and measures of anxiety, depression, and resilience. The PrAS was translated into German (PrAS-G) using the back-translation method. Data were subjected to confirmatory factor analysis and inferential statistics. RESULTS: Complete data were provided by 443 women. Participants were predominantly German nationals, partnered, and well-educated with a planned pregnancy. Approximately half were nulliparous. The eight-factor model was well fitting and consistent with the development of the original PrAS. Criterion-related validity was demonstrated by strong correlations with similar measures (PRAQ-R2, anxiety, and depression) and lower correlations with resilience scores. Predictive validity was shown by group comparisons for: planned versus unplanned pregnancy, trimester, and parity. CONCLUSIONS: The PrAS-G provides a broader assessment of pregnancy-related anxiety than existing measures. Initial evaluation has demonstrated convergent, divergent, and predictive validity, excellent internal consistency, and good model fit indicating promising psychometric properties. The PrAS-G offers a comprehensive assessment of pregnancy-related anxiety which will enable tailored interventions aiming to improve birth experience and well-being of expectant mothers.

The impact of mode of delivery on parent-infant-bonding and the mediating role of birth experience: a comparison of mothers and fathers within the longitudinal cohort study DREAM.

BACKGROUND: The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience. METHODS: This study is part of the prospective cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Our sample comprised N = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables. RESULTS: Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents. CONCLUSIONS: The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.

Psychosocial work stress and parent-child bonding during the COVID-19 pandemic: clarifying the role of parental symptoms of depression and aggressiveness.

BACKGROUND: Parental work stress and impaired mental health seem to have intensified during the current COVID-19 pandemic. Both can have a negative impact on parent-child bonding: psychosocial work stress in the course of a spillover effect from work to family and symptoms of impaired mental health as part of a crossover effect from parent to child. This potentially affects the child's development in the long term. METHOD: This cross-sectional study examined the relationship between psychosocial work stress and parent-child bonding during the early COVID-19 pandemic (May-June 2020). Symptoms of depression and aggressiveness were considered as mediators of this relationship. The sample consisted of employees in Eastern Germany (n = 380; 42.9% mothers, 57.1% fathers), aged 24-55 years, with children aged 0-36 months. RESULTS: In the total sample, an association was only found after adjusting for potential confounders, indicating that higher psychosocial work stress is associated with weaker bonding between the parent and child (ß = 0.148, p = .017, 95% CI [0.566, 5.614]). The separate analyses for mothers and fathers did not reveal a statistically significant relationship between psychosocial work stress and parent-child bonding. In the total sample, the higher the psychosocial work stress was, the higher were the parental symptoms of depression (ß = 0.372, p < .001, 95% CI [3.417, 5.696]) and aggressiveness ß = 0.254, p < .001, 95% CI [1.008, 3.208]). The mental health symptoms in turn were related to weaker parent-child bonding (symptoms of depression ß = 0.320, p < .001, 95% CI [0.345, 0.749]; symptoms of aggressiveness ß = 0.394, p < .001, 95% CI [0.697, 1.287]). The results furthermore suggested that parental mental health symptoms mediate the association between psychosocial work stress and parent-child bonding (symptoms of depression, ab = 2.491, 95% CI [1.472, 3.577] and of aggressiveness, ab = 2.091, 95% CI [1.147, 3.279]). The mediation effect was also found in the separate analyses for the mothers and fathers. DISCUSSION: The results of this study during the early COVID-19 pandemic in Germany highlight the importance of prevention as well as intervention measures in relation to psychosocial work stress that may play a debilitating role in the context of family relationships. In addition, the results suggest that both employers and employees should be made aware of the importance of psychosocial work stress, as it can have a negative impact on mental health, which in turn may have a major influence on family relationships.

Association between maternal employment and the child´s mental health: a systematic review with meta-analysis.

The recent rise in maternal workforce participation has led to more research regarding the role of maternal employment for (early) childhood mental health. This systematic review with meta-analysis covers new evidence on the association of both variables. A systematic literature search was conducted. Studies had to compare children 0-7 years of age on the basis of their mothers' employment status, working amount, employment duration, i.e., how long the mother had been back at work after birth, or timing of return to work. Child mental health was operationalized as behavior problems and prosocial behavior. Narrative and meta-analytic syntheses of evidence were conducted. Maternal employment was associated with more conduct problems but less internalizing behavior problems and anxious/depressed behavior in children; full-time employment was linked to more externalizing behavior problems and more hyperactivity/inattention. Longer employment duration was related to less (internalizing) behavior problems and more prosocial behavior but also more externalizing behavior problems. Narrative syntheses indicated early maternal return to work to be associated with more child externalizing behavior problems and less prosocial behavior. Whether maternal employment is associated with child mental health strongly depends on both variables' operationalization. Especially part-time employment, longer employment duration, and return to work only after the first year postpartum may be beneficial for child mental health. Practical implications pertain to an expanded offer of family leave and the endorsement of maternal employment after the first year postpartum. Here, factors that may buffer the negative associations with full-time employment warrant consideration.

[Fathers and peripartum mental illness: the neglected parent?] / Väter und peripartale psychische Erkrankungen: Das übersehene Elternteil?

Fathers also play an important role during pregnancy and the postpartum period, both for the partner and for the child. With changes in society and increasing early involvement in the care of infants, the father-child relationship has become increasingly more important in recent years. There is growing evidence that fathers can also suffer from mental illnesses during their partner's pregnancy and especially after the birth of a child. As the transition to the role of a father is a major change in a man's life, the birth of a child can be a life event that contributes to a first time mental illness or triggers a new episode of an already existing illness. For example, birth complications can also traumatize the attendant fathers and result in trauma sequelae. Peripartum anxiety disorders and depression probably affect approximately 5% of all men and can among other things have a negative impact on the development of exposed children. Specific screening or even treatment services for affected men are still very rare and little research has been performed. Much less is known about the prevalence, risk factors, and treatment of other mental illnesses in fathers, and there is still a great need for research in this respect.

[Domestic violence and its psychological consequences during the COVID-19 pandemic-key findings from German-speaking countries]. / Häusliche Gewalt und ihre psychischen Folgen während der COVID-19-Pandemie ­ Zentrale Befunde aus dem deutschsprachigen Raum.

The impact of traumatic experiences on mental health during the COVID-19 pandemic has been insufficiently discussed in the German-speaking countries. Against this background, a working group of scientifically and clinically active colleagues was formed on behalf of the German-Speaking Society for Psychotraumatology (DeGPT). The aim of the working group was to summarize central research findings on the incidence of domestic violence and associated psychological distress during the COVID-19 pandemic in German-speaking countries and to discuss their implications. In addition, associations between pre-existing childhood trauma and psychological distress during the pandemic should be illuminated. The present narrative review was prepared for this purpose.The results of the studies conducted indicate high prevalences of domestic violence during the COVID-19 pandemic, which, however, predominantly correspond to pre-pandemic prevalences. Adults with current or pre-existing interpersonal traumatic experiences during childhood or adolescence reported increased psychological distress during the pandemic compared with adults without such experiences. A number of risk factors (e.g., female gender, lower frequency of social contacts) increased the risk of psychological distress and posttraumatic stress disorder symptoms during the pandemic. According to these findings, people with current or past interpersonal trauma exposure represent a vulnerable group with special support needs during pandemic contexts.

Mental health of working parents during the COVID-19 pandemic: can resilience buffer the impact of psychosocial work stress on depressive symptoms?

BACKGROUND: The COVID-19 pandemic has confronted working parents with an accumulation of stressors regarding changes in work, family, and social life, putting their mental health at risk. Stressors include altered working conditions such as working from home or changes in working hours as well as the difficulty to reconcile work and childcare due to the closure of childcare facilities. The present study examined the relationship of psychosocial work stress (i.e., work-privacy conflict and effort-reward imbalance at work) and depressive symptoms in working parents and whether this association was moderated by individual resilience. METHODS: Data of the present study (n = 452) were collected in Germany between May and June 2020 as part of the DREAMCORONA study. A subsample of working mothers (n = 191) and fathers (n = 261) completed the subscale for work-privacy conflict (WPC) of the Copenhagen Psychosocial Questionnaire, the Effort-Reward Imbalance (ERI) Questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), and the Edinburgh Postnatal Depression Scale (EPDS). Multiple linear regression analyses including moderation were performed, controlling for gender, working hours per week, and a lifetime history of depression as potential confounders. RESULTS: Both WPC (ß = 0.336, p < .001) and ERI (ß = 0.254, p < .001) were significantly associated with depressive symptoms. Resilience moderated the relationship between ERI and depressive symptoms (ß = - 0.101, p = .018), indicating that higher resilience weakened the relationship. However, this effect was not found regarding the relationship between WPC and depressive symptoms (ß = 0.055, p = .167). CONCLUSIONS: The results highlight the need for measures to reduce psychosocial work stressors such as WPC and ERI during the COVID-19 pandemic on the one hand and to promote resilience on the other hand. The findings partially support the potential protective role of resilience buffering the association between psychosocial stress and mental health in working parents. Longitudinal studies are needed to confirm this effect.

Severe recalled labor pain and elective cesarean section in a subsequent delivery: a cohort study of Norwegian parous women.

INTRODUCTION: Some women keep on recalling intense labor pain experienced at childbirth to a degree that may negatively affect their life during the postpartum period or lead them to request a cesarean section (CS) in the subsequent delivery. This longitudinal study aimed to assess the impact of severe recalled labor pain from the previous birth on the preference for and delivery by an elective CS in the subsequent delivery. Furthermore, we investigated whether co-occurring maternal demographic, somatic and mental health factors related to the previous and subsequent delivery, explain parts of a potential association. MATERIAL AND METHODS: The study sample comprised 1135 parous women from the Akershus Birth Cohort. Severe recalled labor pain was assessed on a numeric rating scale at pregnancy week 17, and at pregnancy week 32, the preference for an elective CS for the subsequent delivery was assessed. Information on actual delivery by elective CS in the subsequent delivery was retrieved from the electronic birth record. Logistic regression analyses were conducted to examine the impact of severe recalled labor pain on elective CS. RESULTS: Severe recalled labor pain at the previous birth was associated with a preference for an elective CS (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.25-5.67) and actual delivery by elective CS (OR 4.71, 95% CI 2.32-9.59). This association remained statistically significant for the preference for an elective CS (adjusted OR [aOR] 2.12, 95% CI 1.24-3.62) but diminished for delivery by elective CS (aOR 2.30, 95% CI 0.99-5.35) when adjusting for a variety of covariates. Factors related to previous childbirth such as number of years since previous birth, assisted vaginal delivery, anal sphincter lesions, overall birth experience and fear of childbirth were also linked to preference for and delivery by an elective CS. CONCLUSIONS: Women with severe recalled labor pain were about twice as likely to prefer an elective CS compared with women without severe recalled pain. For actual delivery, the significant association with severe recalled pain diminished after adjustment for covariates. However, sample size was small and, irrespective of severe recalled labor pain, preference for an elective CS was statistically significantly associated with actual delivery by elective CS.

The Impact of Maternal Symptoms of Perinatal Insomnia on Social-emotional Child Development: A Population-based, 2-year Follow-up Study.

Background: Poor sleep quality is a common problem in pregnant women, however there is scarce research evidence regarding the association between maternal perinatal insomnia and later social-emotional child development.Participants: This study is part of the Akershus Birth Cohort, a longitudinal population-based study. Birth record and questionnaire data of 1,346 women were used.Methods: Maternal symptoms of insomnia were measured at pregnancy week 32 and at eight weeks postpartum and social-emotional child development was assessed at two years of child age. Correlational and multiple linear regression analyzes were performed.Results: Both, pre- and postnatal symptoms of insomnia were significantly correlated with poorer social-emotional child development two years later (r = 0.09, p < .01 and r = 0.13, p < .001). Adjusting for potential confounding factors, the prospective effect of maternal symptoms of perinatal insomnia on social-emotional child development remained significant in the multiple linear regression analyzes (ß = 0.08, p < .01 and ß = 0. 10, p < .01).Conclusions: We found a prospective effect of maternal symptoms of perinatal insomnia on social-emotional child development, highlighting the potential relevance of both pre- and postnatal maternal sleep for later social-emotional child development. Future studies ought to examine the bio-psycho-social mechanisms and implications of poor maternal sleep in the perinatal time in more detail.

Impact of depressive disorders on quality of life after middle ear surgery in patients with chronic otitis media.

PURPOSE: The aim of this study was to determine whether preoperative depressive symptoms influence health-related quality of life (HRQOL) after middle ear surgery in patients with chronic otitis media (COM). METHODS: This prospective clinical case study was conducted at a tertiary referral center. All 102 patients who had undergone middle ear surgery for COM were assessed clinically and by audiometric testing (pure tone audiometry) in pre- and postoperative settings. Disease-specific HRQOL was assessed by the validated chronic otitis media outcome test 15 (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). General HRQOL was measured using the short form 36 (SF-36). Depressive symptoms were assessed using the patient health questionnaire (PHQ-D). The Charlson comorbidity index (CCI) was used to classify comorbidities. The middle ear status was determined using the ossiculoplasty outcome parameter staging (OOPS) index. RESULTS: After middle ear surgery, the total COMOT-15 and ZCMEI-21 scores improved significantly (p < 0.001). General HRQOL (total SF-36 score) was unaffected by surgery (p < 0.05). Patients without elevated depressive symptoms had significantly better total scores for the COMOT-15 (p < 0.01), ZCMEI-21 (p < 0.001), and for SF-36 (p < 0.001) postoperatively. The results of the multiple regression analyses show that, after adjusting for the OOPS, CCI, and hearing improvement, preoperative depressiveness was significantly associated with worse postoperative COMOT-15 and ZCMEI-21 outcome scores (ß = 0.425 and ß = 0.362, p < 0.001). CONCLUSION: Preoperative depressiveness was an essential predictive factor for HRQOL in patients with COM. This should be considered during patient selection to provide more suitable preoperative counseling.

[Questionnaires for the Assessment of Bonding During Pregnancy and after Birth (Part 3 of a series on psychological assessment during the peripartum period)]. / Messinstrumente zur Erfassung von Bindungsaufbau während Schwangerschaft und nach der Geburt (Teil 3 einer Serie zur psychologischen Diagnostik im Peripartalzeitraum).

Bonding of (expectant) parents with their child is of great importance for the psychological well-being of both the parents and the child. This is especially true if parents suffer from mental health problems like depression. Furthermore, attachment experiences during early childhood can affect both the child's mental health as well as later relationships. However, typical assessment methods like the Strange Situation Test are not very suitable in clinical practice in neonatology and obstetrics, especially since the focus here is primarily on the child's attachment behavior. In addition, bonding with the unborn child cannot be assessed in this way. Therefore, questionnaires represent a more feasible method for the assessment of parental bonding. Instruments have been developed for the time during pregnancy and after birth, but most of them were developed for women. Also, there is a need for further methodological development of these questionnaires. Cut-offs and norm values are highly relevant for clinical practice, but still need to be established in some cases. Assessment of parental bonding using questionnaires can potentially be beneficial and will most likely help to initiate timely supportive interventions.

[Questionnaires for the Assessment of Birth Expectancy and Birth Experience (Part 2 of a series on psychological assessment during the peripartum period)]. / Messinstrumente zur Erfassung von Geburtserwartungen und des Geburtserlebens (Teil 2 einer Serie zur psychologischen Diagnostik im Peripartalzeitraum).

Giving birth is an intense experience and typically accompanied by severe pain. In addition to medical complications, subjective factors are likely to affect the birth experience. These include previous experiences with pregnancy and birth, previous traumatic experiences as well as birth expectations. Various questionnaires allow a standardized assessment of birth expectations and the birth experience. However, to date there is no questionnaire available in the German language that is based on diagnostic symptoms of birth-related posttraumatic stress disorder. Furthermore, current screening-tools were developed for women while men's perspectives have been neglected in research on the parental birth experience. Nonetheless, questionnaires seem to be well suited for the assessment of the birth experience of both mothers and fathers. In this way, support services could be expanded, since parents sometimes report a negative birth experience even in medically uncomplicated births. Along with the goal of enabling parents to have a positive birth experience, the prevention of the development of subclinical or even full-blown posttraumatic stress disorder after birth also plays an important role.

[Questionnaires for the Assessment of Peripartum Depression, Anxiety and Stress (Part 1 of a series on psychological assessment during the peripartum period)]. / Messinstrumente zur peripartalen Diagnostik von Depression, Angst und Stress (Teil 1 einer Serie zur psychologischen Diagnostik im Peripartalzeitraum).

During pregnancy and after birth, women and men may experience symptoms of psychological distress. The most common symptoms comprise pregnancy-related anxiety and fear of childbirth as well as elevated levels of depression throughout the peripartum period. Particularly burdened populations, such as parents of premature infants, are also likely to experience greatly increased stress levels. Adequate questionnaires are needed to provide a standardized and time-efficient assessment of the aforementioned symptoms. However, only few questionnaires have been validated in the German language, and with the exception of the Edinburgh Postnatal Depression Scale, most of them are not very common in research and clinical practice. Furthermore, men are widely underrepresented in these questionnaires. Nevertheless, suitable screening tools are a prerequisite for the prevention and treatment of mental health problems in the peripartum period. Thus, symptoms of acute distress can be alleviated and the manifestation of chronic mental disorders with adverse consequences for the child or the couple relationship can be prevented. Therefore a standardization of the instruments used might be needed for future research and clinical practice.

Posttraumatic stress symptoms following childbirth: associations with prenatal attachment in subsequent pregnancies.

This longitudinal population-based study aimed to investigate the prospective relationship between PTSD symptoms following childbirth and prenatal attachment in the subsequent pregnancy. Data were derived from the Norwegian Akershus Birth Cohort (ABC), a large population-based prospective cohort study. Data from 1473 women who had given birth at least once before and who had completed questionnaires at 17 and 32 weeks of gestation were included. Confirmatory factor analysis of the short version of the Prenatal Attachment Inventory was conducted to validate the scale. Further, structural equation modeling techniques were used to estimate prospective associations of PTSD symptoms following childbirth with prenatal attachment. Finally, to explore potential mechanisms of the association, mediation and moderation analyses were conducted. PTSD symptoms following previous childbirth were found to be prospectively related to higher levels of prenatal attachment in the subsequent pregnancy, while controlling for important confounding factors, such as symptoms of maternal depression and anxiety, previous pregnancy loss, and sociodemographic factors (maternal age, educational level, marital status, and number of children). When fear of childbirth was included as a potential mediating variable, the prospective relationship between PTSD symptoms following childbirth and prenatal attachment in the subsequent pregnancy increased, thereby indicating a suppressor effect. Fear of childbirth did not act as a significant moderator. Our findings suggest that a subsequent pregnancy following a traumatic childbirth may for some women represent an opportunity for a higher level of prenatal attachment, whereas high levels of fear of childbirth may be detrimental for prenatal attachment.

Specific relations of dimensional anxiety and manifest anxiety disorders during pregnancy with difficult early infant temperament: a longitudinal cohort study.

Anxiety in the antenatal period is a common experience, associated with adverse consequences for mother and child. Specific types of prenatal anxiety may have unique associations with infant temperament. This study examines the prospective relationships between general prenatal anxiety, fear of childbirth, and specific prenatal anxiety disorders and early infant temperament 8 weeks postpartum. Data were derived from the Akershus Birth Cohort (ABC), a longitudinal cohort study which targeted all women scheduled to give birth at Akershus University Hospital, Norway. Psychometric measures pertained to general prenatal anxiety (Hopkins Symptom Checklist), fear of childbirth (Wijma delivery expectancy questionnaire), screening for manifest prenatal anxiety disorders based on questions from the mini-international neuropsychiatric interview, and difficult infant temperament (Infant Characteristics Questionnaire). The sample for the present study included 2206 women. General prenatal anxiety, fear of childbirth, agoraphobia, generalized anxiety disorder, and specific phobia presented unique significant prospective contributions to difficult infant temperament 8 weeks postpartum. Separate hierarchical regression models indicated that general prenatal anxiety and fear of childbirth provided the strongest unique contributions. Considering the burden on mothers and the potential long-term effects on child development, the findings of this study highlight the importance of screening women for different types of prenatal anxiety in routine obstetric care. Clinical awareness of the condition and its consequences is warranted. Due to the complexity of infant temperament as a construct with various influences, future research should consider mechanisms and influential factors pertaining to the relationship between prenatal anxiety and infant temperament.

Precarious working conditions and psychosocial work stress act as a risk factor for symptoms of postpartum depression during maternity leave: results from a longitudinal cohort study.

BACKGROUND: The majority of Western women work during their reproductive years, but past research has often neglected the influence of work-related factors on postpartum mental health. Especially postpartum depression (PPD) is an enormous psychological burden for mothers. Therefore, this study aims to investigate the prospective impact of precarious working conditions and psychosocial work stress during pregnancy (such as work-privacy conflict and effort-reward imbalance at the job) on symptoms of maternal PPD. METHODS: In the prospective-longitudinal cohort study DREAM (DResdner Studie zu Elternschaft, Arbeit und Mentaler Gesundheit), N = 587 employed women were questioned about their work during pregnancy and their mental health 8 weeks after delivery. RESULTS: Multiple regression analyses revealed that work-privacy conflict, low reward at work, and precarious working conditions significantly predicted symptoms of PPD, even when controlling for lifetime depression, anxiety, education, parity, and age. CONCLUSION: Our results indicate that psychosocial work stress and precarious working conditions have important implications for maternal peripartum mental health. They might act as prospective risk factors for PPD during the period of maternal leave. Hence, future research should focus on preventative measures targeting work life.