Measuring stress after childbirth: development and validation of the Maternal Postpartum Stress Scale.

BACKGROUND: Due to a wide range of stressors during the first postpartum year, this study aimed to develop and validate a self-report measure of stress intensity specific for postpartum. METHOD: Postpartum women (N= 603) completed the Maternal Postpartum Stress Scale in a cross-sectional online study. They also filled out questionnaires on general stress, depression, and anxiety . Factor analysis, reliability, and validity were examined. RESULTS: Exploratory factor analyses revealed a three-factor structure: Personal needs and fatigue , Infant nurturing , and Body changes and sexuality. The reliability of the total scale and all subscales was good. Significant positive correlation with general stress indicated good convergent validity, and with depression and anxiety good divergent validity. Primiparous mothers had a higher score on the Infant nurturing subscale, and the mothers of infants with health problems had a higher score on the total scale, Personal needs and fatigue, and Infant nurturing. CONCLUSION: Maternal Postpartum Stress Scale is a new, valid, and reliable 22-items scale that measures stress during the first postpartum year. The total scale and tree subscales can be calculated separately to provide detailed information about stressors that mothers struggle with. The scale can be used for research and practical purposes.

Serum catestatin levels in patients with rheumatoid arthritis.

Catestatin (CST) is an important peptide that influences various inflammatory diseases. Our goal was to investigate CST concentrations in patients with RA compared to healthy subjects. This cross-sectional observational study included 80 patients with RA and 80 healthy control subjects. Demographic characteristics and laboratory parameters were recorded. Serum CST levels were determined by an enzyme-linked immunosorbent assay (ELISA). Serum CST levels were significantly higher in RA patients than in the control group (10.53 ± 3.90 vs 5.24 ± 2.37 ng/mL, p < 0.001). In RA patients, there was a statistically significant correlation between CST and patient age (r = 0.418, p < 0.001) and both DAS28 (r = 0.469, p < 0.001) and HAQ scores (r = 0.483, p < 0.001). There was a statistically significant correlation between serum CST levels and RA duration (r = 0.583, p < 0.001). Multiple linear regression analysis showed that serum CST levels retained a significant association with RA duration (ß ± SE, 0.13 ± 0.04, p = 0.002) and DAS28 score (0.94 ± 0.45, p = 0.039) after model adjustment for age, body mass index (BMI) and HAQ score, with serum CST levels as a dependent variable. These findings imply that CST is possibly associated with RA complex pathophysiology and disease activity. However, future larger multicentric longitudinal studies are necessary to define the role of CST in RA.

The relationship between birth satisfaction, posttraumatic stress disorder and postnatal depression symptoms in Croatian women.

Studies show that a woman's dissatisfaction with her birth experience may affect her well-being. This study aimed to examine: (1) the birth satisfaction in Croatian women and compare it with UK normative data; (2) the association of different dimensions of birth satisfaction with posttraumatic stress disorder (PTSD) and depressive symptoms. In a cross-sectional online study, 603 postnatal Croatian women completed the Birth Satisfaction Scale-Revised (subscales: Stress experienced during labour (SL), Women's personal attributes (WA), and Quality of care provision (QC)); City Birth Trauma Scale (subscales: Birth-related symptoms and General symptoms); and Edinburgh Postnatal Depression Scale. Subscale and total scale scores were calculated. Path analysis tested the model of three aspects of birth satisfaction effect on PTSD dimensions and depressive symptoms. The average birth satisfaction score was significantly lower compared to the UK data on the total scale and all three subscale scores. Path analysis revealed that all three dimensions of birth satisfaction (SL, WA, and QC) had an effect on Birth-related symptoms. However, only Women's personal attributes (i.e., feeling anxiety or being in control during childbirth) had an effect on General symptoms and depressive symptoms, as well. Different aspects of birth satisfaction are important for maternal mental health following childbirth.

The role of posttraumatic stress and depression symptoms in mother-infant bonding.

BACKGROUND: There is some evidence posttraumatic stress disorder (PTSD) following childbirth may impact on the mother-infant bond. However, the evidence is inconsistent over whether PTSD or co-morbid depressive symptoms are primarily related to impaired bonding. This study therefore aimed to examine the relationship between PTSD symptoms, depressive symptoms and mother-infant bonding. METHODS: A cross-sectional online study included 603 mothers of infants aged 1-12 months. Measures were taken of PTSD (City Birth Trauma Scale, Ayers et al., 2018) which has two subscales of birth-related PTSD symptoms and general PTSD symptoms; depression (Edinburgh Postnatal Depression Scale, Cox et al., 1987) and mother-infant bonding (Postpartum Bonding Questionnaire, Brockington et al., 2001). RESULTS: Impaired bonding was related to both dimensions of PTSD symptoms and depressive symptoms in bivariate analysis. Path analysis testing the model of whether depressive symptoms mediated the effect of PTSD symptoms on mother-infant bonding found a differential role of birth-related and general PTSD symptoms. Birth-related PTSD symptoms did not have any effect on bonding or depressive symptoms. In contrast, general PTSD symptoms had a direct effect on bonding and an indirect effect on bonding via depressive symptoms. LIMITATIONS: Self-report measures of PTSD and depression symptoms were used. CONCLUSIONS: Further research regarding different aspects of postpartum PTSD, depression and other disorders in the context of mother-infant bonding are needed. Future preventive programs should focus on diminishing symptoms of postpartum PTSD and depression so that the mother-infant bonding remains optimal.

Measuring and conceptualizing PTSD following childbirth: Validation of the City Birth Trauma Scale.

OBJECTIVE: City Birth Trauma Scale is a recently developed scale specifically designed for evaluation of posttraumatic stress disorder (PTSD) following childbirth based on the DSM-5 criteria (Ayers, Wright, & Thornton, 2018). Previous studies showed a two-factor structure of PTSD symptoms in postpartum women; however, more complex models were not tested. This study aimed to validate the Croatian version of the City Birth Trauma Scale and determine the latent factor structure of postpartum PTSD. METHOD: In a cross-sectional study, 603 women completed online questionnaires comprising the City Birth Trauma Scale, Impact of Event Scale-Revised (IES-R), Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale from the Depression, Anxiety, and Stress Scale (DASS-21). RESULTS: Confirmatory factor analysis confirmed the bifactor model of birth-related symptoms and general symptoms had an excellent fit to the data. Both subscales and the total scale showed high internal consistency (α = .92). Convergent and divergent validity testing showed high validity, especially for birth-related symptoms. Discriminant validity was confirmed with primiparous women and women who gave birth by instrumental vaginal delivery and emergency caesarean section having significantly higher scores on birth-related symptoms, but not on general symptoms, suggesting high discriminant validity of the birth-related symptoms subscale. CONCLUSIONS: The City Birth Trauma Scale is a reliable and valid measure. Both total scale score and subscale scores can be calculated. It is highly recommended for use in postpartum population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).